It’s Official: CMS Says Consult Codes are History
The Centers for Medicare & Medicaid Services communicated to Medicare carriers yesterday that consultation codes (99241-99245 and 99251-99255) have been removed from the Medicare Claims Processing Manual. Effective, Jan. 1, 2010, consult codes will no longer be recognized for Medicare Part B payment.
We first learned of CMS’ intentions to eliminate the use of consultation codes (with the exception of telehealth consultation G codes) in both inpatient and office/outpatient settings in the 2010 Medicare Physician Fee Schedule (MPFS) final rule (CMS-1413-FC). This news created such an uproar among health care professionals, industry experts entertained the idea of an appeal.
Despite attempts to negate this policy change by stakeholders, including the American Medical Association (AMA), CMS makes the policy change official in Transmittal 1875, Change Request 6740, issued Dec. 14.
CMS will increase the work relative value units (RVUs) for new and established office visits, as well as for inpatient facilities, and incorporate the increased use of these visits into the practice expense (PE) and malpractice calculations. CMS will also increase the incremental work RVUs for the evaluation and management (E/M) codes that are built into the 10-day and 90-day global surgical codes.
For evaluation services performed in the office or other outpatient settings with dates of service on or after Jan. 1, 2010, physicians and qualified non-physician practitioners should use CPT® code range 99201 – 99215 according to current E/M documentation guidelines.
Hold the Phone
This, however, may not be the final word. Of late, U.S. Senator Arlen Specter has proposed an amendment to temporarily delay the policy change.