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Medicare Elimination of Consult Codes

  1. #1
    Default Medicare Elimination of Consult Codes
    Medical Coding Books
    Does anyone have anything in writing regarding Medicare not allowing the use of consultation codes for 2010? My doctors recieved something from their professional association regarding this and now everyones in a panic! I saw something not long ago about this, but I don't remember where or what.

  2. #2
    North Carolina
    CMS is also proposing to stop making payment for consultation codes, which are typically billed by specialists and are paid at a higher rate than equivalent evaluation and management (E/M) services. Practitioners will use existing E/M service codes when providing these services instead. Resulting savings would be redistributed to increase payments for the existing E/M services.

  3. #3
    Columbia, MO
    I have seen only what Rebecca has posted, in addition I have found a couple of references to a modifier they will create to distinguish the attending physician from the consulting physician.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Right. I read the article the doctors are referring too from the AATS. The problem with these articles is they tend to be slanted toward motivating the doctors to worry. I was hoping I could find something a bit more formal from say CMS. If anyone has seen a more comprehensive article, I would appreciate the info. Thanks!

  5. #5
    Hartford, CT
    Rebecca's link is from CMS and her quote is what CMS is saying. I for one am glad they may do away with consult codes, I'm tired of trying to explain why not everything is a consult just because you happen to be a specialist. I think the consult codes have been overused. When they were originally set up to pay more it was because of the extra work involved in sending a report to the requesting doc, there was no such thing as faxes in the early 80's and most offices were just beginning to use PCs (my how times have changed less than 30 years).

    Of course we all realize that if CMS stops paying for consult codes the other will soon follow suit.

    Doreen, CPC

  6. #6
    North Carolina
    In addition to the CMS link already provided.......

    Begins on page 33
    Last edited by RebeccaWoodward*; 09-10-2009 at 06:21 AM.

  7. #7
    Thanks for all of your input. We have convinced the doctors taht level heads should prevail and everyone needs to calom down. This is a proposal and is not written in stone...yet!

  8. #8
    Seacoast- Dover New Hampshire
    So then we should not believe that consult codes are going away?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  9. #9
    North Carolina
    CMS has made the proposal. If they can find a way without creating total havoc...personally, I think they will...In time.

  10. #10
    I agree with Rebecca, if it may not happen next year but I have no doubt it will happen in the near future.

    We should know in a few more weeks, the final rule is supposed to come out by Nov 1.

    I would suggest being ready for the worst and hoping for the best. Whichever side you are on that could be for them to go away or to stay. It will benefit primary care for them to go away, not so much for the specialists.

    Laura, CPC, CEMC

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