Are Consultation Codes Being Eliminated?

According to CMS, consultation codes are being elminated.   Their news room had lots of goodies to ponder.  You should go read the whole article when you're done reading this.

CMS is also proposing to stop making payment for consultation codes, which are typically billed by specialists and are paid at a higher rate than equivalent evaluation and management (E/M) services.   Practitioners will use existing E/M service codes when providing these services instead.  Resulting savings would be redistributed to increase payments for the existing E/M services.

I have previously stated that the payment differences between consultation codes and admission codes are irrational.  As a hospitalist, if I am asked to consult on a patient, the time commitment can be 1/2 or less.  Most of the history can be "ripped off" from other physician records available in the chart (most notably the admission physician), which is exactly what many physician consultants do.

You can see much more here in my coding lectures or earn CME at E&M University.

Consultants do not get bothered with house keeping hospital orders.  Consultants can write their recommendations and quickly move on to the next patient.  All in all, in my experience, a consult note can take 1/2 as long, or less, has fewer headaches, has less paperwork, AND, get this, pays more than the equivalent level admission note.  It is no wonder why no physician wishes to be the admitting doctor these days and why hospitalists, me included, are being asked to admit healthy 45 year olds no medical problems, except that which requires subspecialist intervention.

There is no clarification on what this means for "use existing E/M codes".  Does that mean consultants would submit admission codes (99221-99223) or does it mean consultants will only submit hospital follow up codes (99231-99233).  I would be interested to know how CMS clarifies this rule.

It also looks like facility fees are going to take a hit as well.

CMS is proposing two changes to address concerns from the Medicare Payment Advisory Commission (MedPAC) and the U.S. Government Accountability Office (GAO) about rapid growth in high cost imaging services.  First, CMS is proposing to reduce payment for services that require the use of expensive equipment which would produce a redistribution of the resulting savings to increase payments for other services, including primary care services.  The current payment rates assume that a physician who owns this type of equipment will use it about 50 percent of the time, but recent survey data suggest this expensive equipment is being used more frequently.  As the use of this type of equipment increases, the per-treatment costs for purchasing, maintaining and operating the expensive equipment declines, making a reduction in payment appropriate.

It looks like primary care is starting to gain some respect, outside of the RUC committee.  Now the question is, will it be enough and will it be quick enough.

Oh, and one more thing,  E/M codes, are inherently flawed in general.  The rules required to meet their standards create an incredible inefficiency in cognitive based medicine.  I often blog that I could triple or quadruple the number of patients I see in a day if I wasn't required to document what I needed to document in order to get paid  and not be accused of fraud.  Perhaps the removal of the consult codes is one step closer to abandoning the E/M a coding system (HURRAY!) that adds nothing of value to patient care, but has guaranteed entire cottage industries and billing support systems, who's expense will be paid for in one way or another in higher health care costs for you, the patient.
You can see much more here in my coding lectures or earn CME at E&M University.