tci Part B Insider - 2006 Issue 2

TRANSMITTALS: Don't Bill A Consult Unless Your Documentation Backs It Up

You can’t bill a split/shared visit as a consult, but non-physician practitioners can provide consults if you meet all the requirements, the Centers for Medicare & Medicaid Services clarifies in Transmittal 788, dated Dec. 20. The transmittal also updates documentation requirements for both the requesting physician/NPP and the consulting physician/NPP, as well as examples for consults. Example: Verbal requests for consults should be documented in writing in patients’ records. Now that CPT 2006 has deleted follow-up inpatient consult codes 99261-99263 and confirmatory consult codes 99271-99275, CMS agrees with the experts that you should be billing subsequent hospital care...

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