Practice Management Alert

CPT did not eliminate the consultation codes, which could be troublesome for your coding know-how. "CPT still recognizes the codes, and they will be in the 2010 CPT book," says Leah Gross, CPC, coding lead at Metro Urology in St. Paul, Minn. "Medicare is just not recognizing them. So far, we haven't been able to get word from any other insurance," she adds.

So far it seems that most private payers are still recognizing consultation codes for 2010. As of early January, many directives still remain unsettled, however. The potential for differing rules between CMS and private payers could spell trouble. "We are going into Dante's Inferno for 2010," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions and Senior Coder and Auditor for The Coding Network. "We will have to manage who does and who does not allow consultation codes." Each payer may decide at will to reject or to accept 99241-99255.

One payer's plan: At the AMA CPT and RBRVS 2010 Annual Symposium in Chicago, a medical director indicated that at least one payer will continue to use consult codes. "Blue Cross Blue hield of Rhode Island will accept either method," said Peter A. Hollmann, MD, the AMA CPT editorial panel, vice chair in his "Evaluation and Management" presentation at the AMA symposium. "I'm not sure how helpful our decision will be for you considering how big a state Rhode Island is," Hollmann joked with attendees.

BCBS RI made this decision for two reasons: "We wanted to allow physicians to report based on both CMS and CPT rules," Hollmann explains. And the contractor is not using the 2010 fee schedule because it can't implement the changes by Jan.1, 2010, Hollmann reported. "Since we're not redistributing the relative value units" to pay more for office visits and hospital care services in exchange for invalidating consult codes, "we won't change our consult policy."

One major payer will stick with office consultation codes (99241-99245, Office consultation for a new or established patient ...) and inpatient consultation codes (99251-99255, Inpatient consultation for a new or established patient ...). UnitedHealthcare (UHC) commercial plans will make no change in payment for consultation codes at this time, according to a UHC e-mail alert. "Physicians may continue to submit claims for these services, and will be reimbursed according to United-Healthcare payment policies." United Healthcare will not be recognizing the consult codes for their Medicare Advantage products and their Medicaid Managed care products, however.

Beware: One Medicaid plan will eliminate consult pay and force you to follow Medicare's rule of using office and hospital codes in lieu of 99241-99255. "For AmeriChoice Medicaid plans that follow Medicare rules for their fee schedules, AmeriChoice will be aligning with CMS rules and implement the change effective January 1, 2010," the e-mail notice states. "For all other Medicaid states, AmeriChoice will follow the UnitedHealthcare commercial position and continue to pay for the consult codes, until directed otherwise by a state to pursue other strategies."

Watch your mail for a UHC payer news notice and an article in the January Network Bulletin.