Read the Latest on CMS Elimination of Consultation Codes

November 6, 2009

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The recent announcement by the Centers for Medicare & Medicaid Services (CMS) to stop paying for consultation services has raised a lot of concern and questions from specialists. The AAN provides the following Q&A to help neurology offices sort through the confusion.

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."

Still have unanswered questions? Submit them to ggjorvad@aan.com and the Academy will answer them directly or add them to the website.