Information on Consultation Codes
The Centers for Medicare and Medicaid Services (CMS) eliminated payment for consultation codes as of January 1, 2010. Some private insurers have also stopped paying for consultations.
- AAN Sounds off to CMS about Consult Codes as part of Proposed 2011 MPFS Comments (August 18, 2010)
- AAN Releases Survey Results: Effects of CMS' Elimination of Consultation Services (July 19, 2010)
- Consult Codes Elimination Reduces Revenue, Forces Practice Changes (June 25, 2010)
- Academy Signs on to AMA Letter Urging CMS Revision of Elimination of Consultation Codes Policy (June 21, 2010)
- Your Feedback Needed: How has the January 1 Elimination of the Consult Codes Affected You? (April 12, 2010)
- AAN Continues Efforts to Legislatively Delay Consults (January 9, 2010)
- UnitedHealthcare Consultation Code Update (January 6, 2010)
- CMS Issues Guidance on Consults (December 17, 2009)
- Some Insurers Indicate No Change in Reimbursement for Consultation Services in New Year (December 14, 2009)
- Contact Congress About Consults (December 8, 2009)
- Medicare Eliminates Consults: What the Academy is Doing For You (November 17, 2009)
- 2010 Medicare Fee Schedule Changes Include Elimination of Payment for Consultation Codes (November 9, 2009)
- Read the Latest on CMS Elimination of Consultation Codes (November 6, 2009)
- CMS to Redistribute Payment for Evaluation and Management Services Starting January 1 (November 2, 2009)
- Academy Responds to Proposal to Eliminate Consultation Codes (September 2, 2009)
What the Academy Has Done
The Academy has signed on with the American Medical Association (AMA) letter to the Centers for Medicare and Medicaid Services (CMS) arguing the elimination of consultation codes has had a larger financial impact than CMS predicted and is also discouraging coordination of care.
A recent survey by the AMA and 11 medical specialties, including the American Academy of Neurology, showed that 72 percent of the 5,500 physicians who completed the survey estimated the elimination of consultation codes had decreased their total revenue by more than 5 percent. Additionally, the letter addresses the issue of the decreasing coordination of care between healthcare professionals, and also issues regarding lower level hospital and nursing home consultations. The letter is requesting a review and revision of this policy during the development of the 2011 Medicare physician fee schedule rule, as revenue losses are much larger than projected.
Click here to read the letter AMA sent to CMS.
Frequently Asked Questions
Question: How can CMS eliminate consultation codes?
Answer: CMS has the discretion, as all payers do, to eliminate payment for existing CPT® codes. The codes will remain in the CPT book.
Question: What will happen if we still bill a consult code after January 1? Will it be denied? Will it be converted to the new patient code?
Answer: Do not bill consults for dates of service after 12/31/09 to CMS. For office visits, you will need to change them to either a new patient visit code (99201-99205) if they meet new patient criteria or established patient visit code (99211-99215) if they do not meet new patient criteria. You will need to do this conversion. Medicare will not do this for you. The inpatient consults will be billed as Initial Daily Care visits (99221-99223). Subsequent inpatient consults will be billed as they are today as subsequent daily care (99231-99233).
Question: How do all the other payers feel about this? Will they continue the consult codes or do away with them also?
Answer: The Academy is approaching private payers to understand their plans with the consult codes and will share more information as soon as it is available.
Question: The definition for billing a consult is very different than for a new patient. Which rules do we follow?
Answer: CMS explains in the final rule: "The major effects of the provision may actually simplify coding because physicians will use the office and hospital visit codes in place of consultations and will not have to determine whether the requirements to bill a consult are met."
Question: How should a neurologist bill for cases where they are brought in as a consult for an inpatient case?
Answer: The admitting physician will bill for their time use the initial hospital care codes (99221-99223) appending a modifier to indicate they are the attending physician; the neurologist will bill their time using initial hospital care codes also.
Question: If a physician in the same practice refers a patient to me for a consultation how will those services be handled after December 31?
Answer: The three-year rule will still apply to referrals within a group practice; if the patient has been seen by any physician in a practice within three years for any reason this visit would be billed as an established patient visit.
Still have unanswered questions? Submit them to firstname.lastname@example.org and the Academy will answer them directly or add them to the website.
Access Q&A from the December 8 Webinar
Detailed questions & answers from the December 8, 2009, Webinar, "Medicare Eliminates Consults: What Neurologists Need to Know by January 1."
Learn the latest about coding changes for 2010—purchase the recording of the December 8, 2009 audio conference/webinar, "Medicare Eliminates Consults: What Neurologists Need to Know by January 1" through The AAN Store®.
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