2010 CPT Changes- Consultation Codes- Medicare

Get ready for changes to Medicare's reimbursement for consultation codes, beginning January 1, 2010. Medicare will no longer recognized consultation codes for payment. Confusion begins with the fact that the 2010 CPT, Current Procedural Terminology, Copyright held by AMA, American Medical Association, All rights reserved, continue to list under the "Evaluation and Management" section, consultation codes (99241-99245) and (99251-99255). To add to the confusion it is unclear as to how private insurance carriers and third party payers will respond to this change.

This change will effect both outpatient and inpatient consultations. Over payments reported in 2001 by Office of Inspector General Report, states that Medicare payed out  approximatley $1.1 billion in overpayment. to providers. It is estimated that 75% of services were reported as improperly documented consultation services.

Billing Solutions beginning January 1, 2010:

If provider would have billed an inpatient consultation (99251-99255) now effective January 1, 2010 to Medicare, that provider should report this services under initial inpatient visit codes (99221-99223). For this to work well, meaning every physician gets paid, the admitting physician needs to append a modifier (Al) subject to change by carrier.

For outpatient settings: Medicare will pay for, new patient visit codes (99201-99205) patients qualify as a new patient if the patient wasn't seen by provider within speciality within the past three years. Medicare will also pay for established patients (99211-99215).

Author: Sherry Marchand-CPMA (Certified Professional Medical Auditor), National Seminar Speaker, Topics included Coding and Billing for Mental Health Services, Coding and Billing Therapy and Rehab, Reimbursement Specialist, Certified Practice Management Consultant. 2O years experience in Coding, Billing and Compliance.