Gastroenterology Coding Alert

It's true that Medicare neutralized its consult code sets for 2010, eliminating relative value units (RVUs) for 99241-99255.

In the wake of wiping out consult codes, CMS will raise payment for the other E/M codes, confirms Quinten A. Buechner, M.S., M.Div., CPC, ACS-FP/GI/PEDS, PCS, CCP, PAHCS:CMSCS, president of ProActive Consultants in Cumberland, Wis.

Impact: "Obviously, this will result in an income increase for primary care specialties, and a decrease for specialists who use consult codes," says Betsy Nicoletti, MA, CPC, president of Medical Practice Consulting in Springfield, Vt.

The 2010 Medicare fee schedule will increase relative value units (RVUs) for all E/M codes, including:

• 99201-99215 (Office or other outpatient visit for the evaluation and management ...)

• 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: ...).

• 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components:...).

CMS has increased the RVUs for 99201-99215 by about 6 percent, for 99231-99233 by about 5 percent, and for 99221-99223 by about 2 percent. For instance, check out the RVU change for 99214 ( a detailed history; a detailed examination; medical decision making of moderate complexity ...): in 2009, its RVUs were 1.42; in 2010, 99214 is worth 1.50 RVUs.

"I suspect that there will indeed be a negative effect overall for gastroenterologists. From what I have been seeing so far, the change in this area is expected to be in the negative-1 percent range, which is not taking into account the current 21.2-percent looming reduction based on the Medicare Fee Schedule for 2010," relays Vicki Farretta, CPC, CMA, director of patient financial services for Washington's Puget Sound Gastroenterology, PS. (For more information on Medicare's physician reimbursement plans for next year, read "Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010" at www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf.).

Despite the potential downturn in revenue, the elimination of consultation codes could make things easier for the coder. You won't have to distinguish transfer of care versus request for opinion, or worry about the "5 Rs" of successful consult claims.

Often, providers "have had a hard time distinguishing between consults and transfer of care; it can often be left up to the subjectivity of the auditor as well," Faretta explains. The consult code deletion "will take away that particular gray area," she says.

Medicare won't pay for consults in 2010, but private payers have yet to comment officially on the 99241-99255 codes (remember, the code set is in CPT 2010).

Practices that want to get the compliance jump can start surveying their commercial carriers to see how they'll want consults coded next year, says Buechner. Many will follow Medicare's lead, but some may still want to see 99241-99255.

If that is the case, then get ready for some difficult claim processing for patients who have Medicare as a secondary payer. It is not clear how Medicare will pay crossover claims from private payers for codes 99241-99255.

Great idea: If the private payers are following Medicare's "no consult code" policy, you probably need to renegotiate contracts so you get extra payment for the other E/M codes that have increased RVUs for 2010, Buechner recommends.

The article "Bring in $400+ for Breath, FOBT-E/M Alone with CLIA Waiver on File," in vol. 11, no. 9 of Gastroenterology Coding Alert contains unclear coding information.