FPD Private News & Updates2

The Federation Continues to Oppose CMS’ Decision to Eliminate Billing for Consultation Codes

Many voices that speak on behalf of physicians specialty-wide have long expressed strong concerns about the Centers for Medicare & Medicaid Services’ (CMS) proposal to eliminate billing for consultation codes. These voices went unheard when CMS announced its final decision to stop paying for consultation services as of January 1, 2010.

The Federation opposes all public AND private efforts to eliminate payments for inpatient and outpatient/office consultation codes and supports legislation to overturn CMS’ decision.

HOW IT WILL AFFECT YOU

First of all, medical practices will not be able to bill consultation codes to Medicare (for now, that is - private payers almost always seem to follow what Medicare does) past December 31, 2009. Instead, they will have to report either a new patient visit code (99201-99205) or established patient visit code (99211-99215) for outpatient services; or an initial hospital care visit (99221)-99223) or subsequent hospital care visit (99231-99233) for inpatient services.

Second, inasmuch as this change will affect most medical practices, some specialists such as Gastroenterologists, Neurologists, Endocronologists, and Oncologists, who code almost all of their new outpatient and initial inpatient work as consultations, could see substantial reductions in reimbursement. Even with Medicare’s 6% adjustment to the outpatient E&M work RVUs and 0.3% adjustment to the remaining inpatient E&M work RVUs, some practices could face significant loss of income. This on top of the still possible 21.2% cut to Medicare rates that’s still looming on the horizon.

Not only will this change cause revenue loss for some specialties, some specialists will have to change the entire way they’ve built their practice and their relationships with physicians who refer patients to them. Many fear the change will cause more problems than it will solve. The problem this is supposed to be solving, of course, is the years of confusion and improper use of the consultation codes, most of which could be attributed to the discrepancies between CMS rules and the AMA’s CPT Manual. But it had been discovered that CMS had made an estimated billion in overpayments to physicians for services billed as consultations, but which did not meet all of the CMS requirements.

So, a paradigm shift and loss of revenue is what you may face for 2010. The Federation will continue to monitor and work on this issue and will make information available as it becomes available to us. We of course want to hear from you if you start seeing these changes take effect and if you receive similar changes among the private payers with which you may be participating.

Any questions may be directed to lyndafpd@aol.com.