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Medicare Inpatient Consult Code/Modifier - CG13

Posted: May 11, 2012

Can anyone help me with the code used for inpatient consult and a modifier for Medicare? Having reimbursement problems with this one. Thanks

What codes are you trying to use? - Hmmm

[ In Reply To ..]
And explain the reason for the modifier. What exactly did your doctor do?

And you are following the latest CMS guidance on consults? Google it if you haven't yet.

Where is the OP??? Why ask for help??? - Want to help

[ In Reply To ..]
Why do people ask for help and not return?

It may be that they are busy, but they asked for help. That obligates the helper to keep checking back again and again and again.

If I asked for help, I think I would be checking in at least once a day.

I was hoping you would reappear to explain further so I could tell you what to use. Doesn't appear that is going to happen, so here is the best answer I can give.

Medicare is telling you to stop sending them that code because they do not accept it. You will have to use whatever the service actually IS. The fact that your doctor got a request for a consult does not make it one. Even if it fits the AMA definition, CMS does not accept those codes. The fact that you think you need a modifier with this tells me you are trying to code something in addition to this and you are probably doing that incorrectly as well.

You need to use one of the hospital E/M codes, but I can't tell whch because you aren't around to explain. I can't tell you what is wrong with the modifier for the same reason. Did your doctor perform a procedure? Was it a procedure that is not included in the work of an E/M? Is the modifier itself just wrong? I can't tell from what you gave us.

Needing help - CG13

[ In Reply To ..]
Sorry - I have been out of town all weekend and did not get a response until after I left work Friday. Heard something at a conference on coding a few weeks ago that Medicare now requires a modifier code on consults. I had 2 kick out and thought that might be why. I was just wondering if you or anyone is familiar with this change as I cannot find it anywhere. Thank you for your help. It is very appreciated.

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