MEDICARE CONSULTATION CODES CHANGES
Effective for services furnished on or after January 1, 2010
As of January 1, 2010 Medicare has eliminated Consultations Codes (99241-99245) and (99251-99255). This means that all providers billing Medicare must use another code for the service and may not bill the patient for a non-covered service.* Currently this change only pertains to Medicare. However Medi-Cal is expected to follow this change shortly.
In the inpatient hospital setting and nursing facility setting, providers who perform an initial evaluation for Medicare patients may bill an initial hospital care visit (CPT codes 99221-99223) or nursing facility care visit code (CPT 99304-99306).
In the office or outpatient setting, provider may bill CPT codes 99201-99215. Selection will depend on the complexity of the visit and whether the patient is a new or established patient.
In all cases the physician should bill the available code that most appropriately represents where the visit occurred and identifies the complexity of the visit performed.
IF YOU ARE THE ATTENDING PHYSICIAN: Append the Modifier -AI to the initial hospital care code. This identifies the physician who oversees the patient's care from all other physicians who may be furnishing specialty care. All other physicians who perform an initial evaluation on this patient will bill only the E/M code for the complexity level performed.
DOCUMENTATION: If you are used to billing only consultation codes, it is important to become familiar with the documentation requirements necessary to bill other codes - as they will vary from the consultation code requirements. If you still provide consultations for other payors it is recommend that you still meet the three documentation requirements - documents the requesting physician's name, render your opinion and provide a report back.
RESOURCES: The Compliance Office Representative: Emma Cuenco, CPC [email protected].
Your Billing Office Representative
Medicare Claims Processing Manual, Publication 100-04, Transmittal 1875, December 14, 2009http://www.cms.hhs.gov/transmittals/downloads/R1875CP.pdf
CMS, MLM Matter MM6740: Revision to Consultations Services Payment Policyhttp://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf
* There is a limited exception for telehealth consultation G codes.