Newest crosswalk for MCR consult codes

Medicare has issued a ruling that new states consult codes 99251 and 99252 my be crosswalked to subsequent E/M visit codes 99231 and 99232 respectively if documentation supports the code(s) vs having to crosswalk these codes to the unspecified codes 99499; however I do not see where consult code 99244 has been changed (established outpatient) in this recent ruling. 99244 still does not crosswalk to any established patient visit code, so I'm assuming that 99244 will,at lease for now, continue to crosswalk to 99499, unspecified.

Am I correct in my interpretation of this very recent change? Does anyone see another point of view for crosswalking 99244?

Crosswalking Consults

This is what I see go on and not necessarily what is CORRECT .... I see 99244 being billed as 99204.

Please send some CMS links to more official information; I'm interested :)

thanks

I WANT THAT REFERENCE too

Where did you read that about 99251 fromCMS?

No, 99244 would not be an unlisted code

Look at the article on the rule change in Codapedia. 99244 required all three of: a comprehensive history, comprehensive exam and moderate MDM.

For an established patient, select the code based on the history, exam and MDM in the note.

Look at the requirements for a 99214 ( two of three: detailed history, detailed exam, moderate MDM) or a 99215 (two of three of comprehensive history, comprehensive exam and high MDM)

When deciding what to bill:

First select the appropriate category of code (new, established, initial hospital)

Then, select the level of service based on history, exam and MDM.

Read the article CMS eliminates payment.... for more detail.

Don't bill 99499 for an established patient visit that was a consult.

99244 and 99214

Thanks for your respose. I do understand the conversion/crosswalk, however, my question is: Since 99244 does not have a comparable crosswalk to an established office code (like you indicated, neither 99214 and 99215 crosswalk) what do you suggest?

99244 and whatever code

If the patient is established, then you'll select 99212--99215 series of codes. Then, you have to base the level of service on the history, exam and MDM documented. You can't cross walk them at the back end: the MD/NPP must select the code based on what was done and in the note.

I wish it were easier.

There is a grid in the consult article (type in UPDATE in the search box and you'll find the article) that shows the level of history, exam and MDM for these codes.

I haven't seen any clarification from CMS about the 99251-99252 issue, but was out of the office all last week.

Mdm

Let MDM element drive code selection

99244 crosswalk

at our practice, a GI group, our society ASGE has recommended (and we follow) the crosswalk from 99244 established pt. to a 99214 or 99215 based upon documentation. A new pt would be 99204 or 99205- again based upon documented work done.

Medicare clarified how to code 99251--99252

Their new transmittal clarified: if the inpatient consult (that is, the initial hospital service by the specialist) does not meet the criteria of a 99221, then use the subsequent hospital visit codes. They are instructing carriers/contractors not to deny if a subsequent visit is received and no initial service.