Wiki Changes to Consult Codes 99241-99245 In 2021?

JulieKasik

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So they are changing the way outpatient E/M coding is in 2021, deleting the 99201 and only requiring the codes to be reported based on time or MDM, however I have not seen any mention of things changing for the consult codes. Seems odd considering the codes follow the same general principals. On any webinars have any of you heard any mention? I know with CMS not paying them, and other insurance companies following suit I thought honestly they would push to delete them all together. Just wanted to put the feelers out there to see if anyone had heard anything.

Also lame they did not change the way inpatient is done. I think inpatient needed more changes then outpatient. But I digress.
 
Consultation codes are almost never used and especially not supported. The actual number of consultations that actually qualify to be billed, and the insurance still allows them to be billed is so small that to me it's not worth wondering about. Medicare has not paid consults in years, most private insurance has followed Medicare, and most E/M visits which the physicians label as a "consultation" are in actually not consultations. Medicare does not pay for consultations any longer because they performed a three year audit on all claims that were submitted with consultation codes. The failure rate was 95% for three years with no improvement even though CMS reached out to coders through every avenue they could think of. So after three years of 95% inaccurate submission, and no improvement from coders, CMS stopped paying them.
 
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