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Written by Reed Tinsley, CPA | November 24, 2009
Consultation Crosswalk Codes
Frank Cohen (www.cpahealth.com) provided us with the table below; this will be important for predicting future utilization and revenue (cash flow) since CMS is doing away with consult code billing. This is the official Consultation Crosswalk Codes table from CMS.
Choosing the Right E&M Code: Avoiding Pitfalls in Consultation Coding
While it may appear tempting to just use Consultation Crosswalk Codes by changing a 99241 (outpatient consultation-new patient) to a 99201 (established patient office visit), it's important to realize that these codes indicate various service levels.
The key is to have correct documentation. Instead of a direct conversion, a consultation code should be substituted with the appropriate visit code based on the visit information. Did the encounter include a thorough history, examination, and medical decision-making? This points to a higher-level E&M code, such as 99214 (established patient office visit complex).
This change guarantees appropriate remuneration and represents the actual service delivered. Remember, following the 95 or 97 documentation criteria is essential. Do not be lured by shortcuts. a full review of the encounter.
For further insights and professional guidance, REED TINSELY, CPA, is here to assist you in navigating these changes effectively.
| OFFICE CONSULTATION CODES | INPATIENT CONSULTATION CODES | ||||
| SOURCE | DESTINATION | MAPPING | SOURCE | DESTINATION | MAPPING |
| 99241 | 99201 | 50% | 99251 | 99221 | 70% |
| 99211 | 50% | 99304 | 30% | ||
| 99242 | 99202 | 50% | 99252 | 99221 | 35% |
| 99212 | 50% | 99222 | 35% | ||
| 99243 | 99203 | 50% | 99304 | 15% | |
| 99213 | 50% | 99305 | 15% | ||
| 99244 | 99204 | 50% | 99253 | 99222 | 70% |
| 99214 | 50% | 99305 | 30% | ||
| 99245 | 99205 | 50% | 99254 | 99222 | 35% |
| 99215 | 50% | 99223 | 35% | ||
| 99305 | 15% | ||||
| 99306 | 15% | ||||
| 99255 | 99223 | 70% | |||
| 99306 | 30% | ||||
