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Thread: consultation changes for 2010

  1. #1

    Default consultation changes for 2010

    AAPC: Back to School
    hopefully someone can clarify that CMS has made a final ruling on 2010 Consultation changes for specialists? i am unable to locate any ruling on the CMS site and only bits and pieces on the AMA site and HealthLeaders media.

    are specialists only able to bill for new pt or follow up pt codes for 2010 and could someone send me CMS site for final ruling? i called medicare and they do not have a clue about the decision. please help and if they can only bill new pt. codes and follow ups what happens if they present with a new problem??


  2. #2

    Talking CMS ruling on consults

    Ya just gotta love CMS, they drop a bombshell but do nothing to follow up with helpful information. I too am trying to find out. An inside tip from HighMark, CMS, told me that yes CMS indeed ruled on it but has not made a formal announcement but that it should be forthcoming.

    Also, what happened to RAC? Seems it just fell of the face of the earth??? Of course I don't have three weeks to devote to searching the CMS website either!


  3. #3

    Default 2010 Consultations

    The information you are looking for regarding consultation codes for 2010 is located in the final rule published in the 11/25/2009 federal register. CMS is no longer reimbursing for the consultation codes, most likely other payors will follow suite. The consultation codes are still valid CPT codes. Hope this helps!

    Last edited by mmoroney; 12-07-2009 at 01:35 PM.

  4. #4


    Highmark is planning a webinar in January regarding the Consultations. It isn't up on their website yet, though. But, at least it's coming. I think they showed it as tentatively slated for January 13th.

    It was information that was included on one of the slides from todays webinar I attended, but not on the slides that you get to print-out.
    ~Ursula, CPC~

  5. #5

    Default When are they planning on filling us in?

    So, Medicare decides to eliminate the Consult codes, ok- I guess we have to deal with this.
    So my questions are:
    1) What am I allowed to bill for doing the report that still needs to be done for the referring doc because even though we cannot BILL for a CONSULT, it will still BE a CONSULT? 99080? 99499?
    2) Since consults are typically more extensive are we going to be able to get paid for prolonged services codes (99354, 99356) or are they going to hold up the entire claim until we submit notes on every claim like what's been going on with our geriatrics physician?
    3) Finally, and most importantly, I've read more than enough on the ruling, how about giving us some final details on HOW we are going to be billing for Inpatient Consultations as Subsequent visits? Just stating that "we will create a modifier" does not help me. Telling me WHAT the modifier is and WHICH doc will use it and letting me know sooner than 2 weeks before this new ruling goes into effect......THAT would be helpful.

    And while I'm on a roll - how about giving us the final fee schedule details instead of just the RVU's which are a royal PITA to figure out. This way we can at least get a general idea of how much of a revenue loss this will be.

    Well now, I feel a little better now that I vented. If anybody has any insight, please share- it would be much appreciated.

    p.s.- oh and I can't wait for the other payors to "follow suit". Especially the ones who increase their required copays to specialists even though they do not pay any more that a GP. Now the insurance co's can make even MORE profits!

  6. #6
    Join Date
    Apr 2007
    Santa Rosa

    Question Consults and the ABN

    does that mean that we can have the patients sign an ABN like we do for physicals and charge the patient?

  7. #7
    Join Date
    Apr 2007
    Columbia, MO


    Quote Originally Posted by dentfam View Post
    does that mean that we can have the patients sign an ABN like we do for physicals and charge the patient?
    No, the service of a consultation is still a valid and recognized service. Read careful... it says that CMS considers the codes for consultation as invalid codes. You have clear instructions on how to bill tese services you cannot bill the patient with an ABN.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8


    Has anyone heard yet the modifier admitting/attending physicians are to use to distinguish them from the specialists in the inpatient setting?
    Kolbie Mangold,CPC

  9. #9

    Default Consultations

    I've heard that the modifier will be AI (i) not a 1 (one). How confusing is that going to be. I wonder if specialists will have to rely on the admitting physicians to put this modifier one before they'll pay?
    Wendy P. Wright, CPC, CPMA, CEMC, CHC
    Compliance Coordinator
    CaroMont Health

  10. #10

    Smile Consults for 2010

    You can find the final ruling in the Federal Register, November 2009. These sort of things are always posted in there.




    Good Luck!

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