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consultation changes for 2010

  1. Default
    Medical Coding Books
    Medicare in NY released it's fee schedule. No consultation codes.

    I am not happy with this as I work for an oncologist and she is always doing consultations.

    Hopefully CMS will reverse it's decision as physician's cannot take any more cuts. Pretty soon all we will be getting paid will be the patient's copay....

  2. #22
    Default
    Quote Originally Posted by reginar View Post
    pretty soon all we will be getting paid will be the patient's copay....
    lol...

  3. Angry Consultation codes definitely omitted
    Hello all. I am in NY and just returned from a Medicare seminar. Unfortunately it is not good. It was just confirmed that Monday night, the finalization was passed on the discontinuance of consultation codes. It is unfortunately the truth.

    The other thing is that the modifer is AI (as in ARTIFICAL INTELLIGENCE).

    Just thought I would post for all to see that it is true....no consultation codes in 2010.......

  4. #24
    Location
    North Carolina
    Posts
    3,126
    Default
    I believe this was posted on another link but below is the finalized CR...

    http://www.cms.hhs.gov/transmittals/...ds/R1875CP.pdf

  5. Default
    Senator Arlen Specter has proposed (this week) an amendment postponing the elimination of consultation codes for one more year. He'd have to get congress to pass the amendment before the end of the year, in order to get the extension.

    http://www.news-medical.net/news/200...applauded.aspx
    ~Ursula, CPC~

  6. #26
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by tammster View Post
    Senator Arlen Specter has proposed (this week) an amendment postponing the elimination of consultation codes for one more year. He'd have to get congress to pass the amendment before the end of the year, in order to get the extension.

    http://www.news-medical.net/news/200...applauded.aspx

    I just can't see that happening....

  7. Default
    I would think that if it was such a concern for him, he should have started earlier on his crusade.
    ~Ursula, CPC~

  8. #28
    Default Consult changes
    Here is what I've found regarding billing:

    By now, we have all heard that CMS will not pay for consuts starting Jan 1, 2010, but we had lingering questions about how to submit claims. Dec 15, CMS released a transmittal, dated Dec 14, 2009, which answers these questions. The transmittal is attached.

    For services that were outpatient consults, provided in the office and outpatient department, use new or established patient visit codes. (99241--99245 will be 99201--99215). Review the definition of a new patient from the CMS manual:

    Interpret the phrase “new patient” to mean a patient who has not received any
    professional services, i.e., E/M service or other face-to-face service (e.g., surgical
    procedure) from the physician or physician group practice (same physician specialty)
    within the previous 3 years.

    Some patients, who would have been office/outpatient consuts will now be established patients. The consult codes were not defined as new or established. Specialty designation is critical, as well as the three year time period. Remember that location is not a factor. Whether the physician or the physician's same specialty partner saw the patient in the hospital or office doesn't matter in the specialty designation.

    Admitting physicians must now use modifier AI (capital I, not number 1) on their claim forms to indicate they are the admitting physician when they bill for the admission, 99221-99223. All other physicians who see a patient for the first time will also bill using the initial hospital services codes (what we call the admission codes 99221-99223). CMS has instructed carriers to pay for multiple "initial" hospital services for the same patient, even if they are on the same day. Remember, however, that physicians of one specialty in a group can only bill one of those/admission. The AI modifier needs to be attached only to the initial hospital services codes, not to the subsequent visits or discharge services. However, CMS has instructed carriers to ignore the modifier if it appears on other line items during the admission.

    How does a physician bill who is called to the ED to see a patient, who is not admitted? Use the ED department codes (99281--99285). Previously, these were billed with outpatient consult codes, if the criteria for a consult were met. This means, physicians of multiple specialties will all bill ED codes on the same patient, on the same date of service, perhaps for the same diagnosis. We can only hope that the Medicare Administrative Contractors will not deny these claims.

    If a patient is in observation status, the admitting physician uses the OBS codes without a modifier, 99218--99220 or 99234--99236. Other physicians who are called to see the patient should use office and outpatient codes, 99201--99215, keeping in mind the definition of a new patient visit.

    Hospitalists will be able to bill the initial hospital services codes for their post-op evaluations, by my reading of this change request, for medically necessary, non-surgical management of medical problems. Previously, they were limited to a subsequent hospital visit. I will change the Codapedia article on that topic as well.

  9. #29
    Location
    Phoenix, AZ
    Posts
    620
    Default
    Hi there,

    could you post the transmittal number, please? I need to take this to my providers and they want the "official" CMS word.

    THANKS!
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  10. #30
    Location
    North Carolina
    Posts
    3,126

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