Inpatient Consulting Codes Eliminated By Medicare: How To Get Paid.
Medicare has released its final 2010 Physicians Fee Schedule. One of the most significant changes was the elimination of payment for codes for consultation codes as of January 1, 2010.
You can still bill for consulting services, it just means that you will have to bill these services differently than you do now. This is the information that you need to know.
1. Consultation codes 99241-99245 (outpatient/office) and 99251-99255 (inpatient) have been eliminated starting January 1, 2010. Telehealth consultation G-codes (G0425-G0427) will not be eliminated.
2. Beginning January 1, 2010, CPT codes for new (99201-99205) or established (99211-99215) patients should be used to replace consulting in the office/outpatient setting.
3. As of January 1, 2010, CPT codes in the inpatient hospital setting (99221-99223) should be used to replace inpatient consultation codes (99251-99255), and for nursing facility consulting use codes (99304-99306).
4. To distinguish the difference between the admitting doctor of record from the consultants for initial hospital inpatient and nursing facility admissions, CMS will develop a modifier. Currently, modifier “AI” is for principal physician of record; however CMS has not finalized the modifier to be used for consulting.
5. Medicare states that its changes are budget neutral. RVUs for all E/M codes have been increased in an attempt to offset the fees lost from the elimination of consultation codes. The increase in Evaluation & management payments is approximately 6% for outpatient/office codes and 2% for inpatient codes above 2009 levels.
An important note regarding commercial or private insurance. No information has been released by other third party payers regarding payment for inpatient consulting codes codes as of yet. However, if a patient has Medicare as a secondary payer, a decision will need to be made by the physician as to how you will report the consulting.
Any consulting claim filed with a commercial insurer such as Blue Cross or Aetna who is primary using the eliminated consulting codes when Medicare is secondary would result in a denial for the secondary claim by Medicare. In those instances where Medicare is secondary, you may want to consider using the new guidelines as stated above for reporting consultation codes.
Another note. If you have not updated your enrollment information with CMS since November 2003, you must do so by April 5, 2010. Although enrolled in Medicare, many healthcare providers who are eligible to refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the CMS provider enrollment, chain and ownership system (PECOS) and also contains the doctor’s national provider identifier (NPI).
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