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Deleting Medicare Consult Code Could Hurt Patients, Say Doctors

Cheryl Clark, for HealthLeaders Media, December 4, 2009

Under current CMS rules, the CPT code for consultation calls for reimbursement that is between $20 and $50 higher than for a comparable office visit.

CMS officials has not responded to requests for comment.

Mapes met with CMS officials Nov. 24 about the elimination of CPT codes 99241-99244 for office or other outpatient consults and 99251-99255 for outpatient consultations. "Rather, CMS has instructed physicians to bill using the new or established patient codes instead."

Physicians who are concerned about the change say the elimination of these codes will necessitate substitution of evaluation and management codes, which pay significantly less.

"Unless the January deadline is moved back significantly, we do not see how Medicare will have sufficient time to educate physicians about the new modifier or to develop and widely distribute guidance —including a crosswalk —on how to use the visit codes. Time is also needed to educate secondary payers and provide them with enough time to handle impacted crossover claims."

Maves wrote that CMS rejected the AMA's CPT code panel's new language that would have clarified how consultation codes should be applied. "CMS apparently is rejecting this effort because there was not ‘universal agreement' among physicians on what the appropriate policy should be.

"Yet CMS' substitute policy has far less acceptance among physicians and has not been subjected to the cross-specialty scrutiny that could have identified and avoided some of the confusion and concerns the new policy has engendered among physicians."

The AMA's House of Delegates in November called for a repealing the new policy altogether.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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