Survey Says: Cut Consult Codes Undermine Care

When the news was first released that Medicare would no longer cover CPT® consultation codes beginning Jan. 1, the Centers for Medicare & Medicaid Services (CMS) predicted that no specialty would see Medicare revenues decline by more than 3 percent due to the change. Industry stakeholders, however, feared the policy change would force physicians to implement cost-cutting measures that would ultimately undermine care. Now, nearly nine months later, a recent survey supports those fears.

According to a survey of approximately 5,500 physicians conducted by the American Medical Association (AMA) and 17 specialty societies, practices have seen revenue decrease as much as 20 percent in some cases and many physicians have already implemented various cost-cutting measures.

“Thousands of physicians say they have been forced to adopt a number of damaging cost-cutting measures as a result of Medicare discontinuing its use of consultation codes …,” American Medical News reports.

According to the AMA, there are many “unintended consequences” as a result of consult codes no longer being covered by Medicare. To learn more, read the article “Nixed Medicare Consultation Codes Force Doctors to Make Cutbacks” on amednews.com. Survey results are given at the end of the article.

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4 Responses to “Survey Says: Cut Consult Codes Undermine Care”

  1. James B. Davis says:

    This is what physicians and other health care providers should continue to expect if the health care reform legislation is not repealed. Every day there are new reports of increased costs, reduced benefits, and unintended (or undisclosed) consequences.

    Physicians and other providers need to work together to help repeal this economically devastating legislation and then work together to make meaningful changes that truly benefit patients, providers and payers.

    James B. Davis, President
    Practice Management Information Corporation (PMIC)
    http://pmiconline.com

  2. Pawan Arya, MBA, CMPE, CPC, CPC-H says:

    Apart from reducing reimbursement, and increasing cost, what is rarely mentioned or acknowledged is the escalating burden of compliance with increasing regulations. I think there should be a point added towards cost RVU every time a regulation is added, or changed to compensate the providers for cost of compliance.

  3. Catherine Hodges,MBA says:

    When CMS nixed the reimbursement of consultation codes;the fact is, CMS is suggesting the fraudulent action of coding by the Consulting physician. The very relationship of the Primary provider to the Specialist is to provide a superior knowledge of disease management for medical decision making and medical neccessity.
    The Medical Record by both providers will read that a Consultation was requested and a Consultation was performed regarding the patient.
    The E/M codes do not touch the intensity of the higher knowledge sought from a specialist.

    CMS is urging and supporting fraudulent coding by medical professionals and seeking endorsement from AAPC to participate, which violates the very foundation and morals of my AAPC.

  4. Sheryl Forrester says:

    As a compliance professional I agree the external reviews (RAC, MIG, CERT, etc) in place are an increased burden and are actually preventing me from completing useful proactive work for my practice but I have been teaching providers how to use the consult codes for the past 5 years and am happy to see them gone.

    It was a concept that providers did not understand and was very hard to explain. I would repeat myself with almost every group. You are a consultant but that does not mean the service you provide meets the requirement of a “consultation” from a coding perspective. I have performed chart reviews for over 15 years across mulitple specialty groups and organizations. I rarely see documentation by both the requester and the consultant that supports the consultant service.

    If physicians were reimbursed on the intensity of their knowledge or expertise we would have to completely revise the payment system. The payment system is based on the amount of work performed and documented. I agree it does not take into consideration the higher level of expertise that is being sought.

    CPT codes are not up to date with how medicine is currently practiced. That is why we struggle because we are left to apply an antiquated coding system to our current practice.

    Payment for consultation codes does not fix this broken system.

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