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As per the 2010 fee schedule, for Medicare patients you’ll be skipping the 99241-99255 (consultations) section of CPT. In the new year, you will report an appropriate non-consult E/M code for Medicare patients even if the visit meets CPT’s consult requirements.
According to the Medicare Physician Fee Schedule (MPFS) Final Rule, “Starting January 1, 2010, we will eliminate the use of all consultation codes on a budget neutral basis by increasing the work RVUs for new and established office visits and for initial hospital and initial nursing facility visits.”
Before: Previously, if a cardiologist in the office setting performed a consult for an established patient with 786.50 that involved detailed history, detailed examination, and medical decision making of low complexity, you would report 99243.
Now: But in 2010, for Medicare patients, you’ll have to report 99203 if the consulting cardiologist or another physician of the same group practice and specialty hasn’t seen the patient in the last 3 years. And in case the patient was seen within the last 3 years, you would have to bill 99214 because Medicare will no longer accept consult codes.
Watch out: The CPT 2010 manual does not delete the consult codes; as such, other payers may continue to accept them. You should therefore check so that you meet all necessary requirements such as having a written request on file.
It pays to know: Even if only Medicare does away with consultation codes, specialty practices will feel the pinch for sure.
For the latest on , there are various one-stop coding websites, which come loaded with all the changes. So sign up for one today and be prepared for what’s to come as far as consult codes are concerned.
We provide you simple, instant connection to official code descriptors & guidelines and other tools for , that help coders and billers to excel in the work they do every day. Article Source: