Consult Codes Eliminated By Medicare.

According to CMS, consultation codes are being eliminated.   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 CPT® codes are irrational.  As a hospitalist, if I am asked to consult on a patient, the time commitment can be half or less than the time I spend on an admission, but I'll get paid more.  Most of the history can be obtained from other physician records available in the chart  (usually the admitting physician).

Consultants can write their recommendations and quickly move on to the next patient.  All in all, in my experience, a consult note can take half as long, or less, has fewer headaches, has less paperwork, and 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 are being asked to admit healthy 45 year olds no medical problems for us to address.

Consult have been replaced by the already present initial inpatient admission codes.  That means consultants should use CPT® 99221, 99222 and 99223 for their initial visits.   Reference the AMA's CPT 2018 Standard Edition as the definitive authority in CPT® codes.   In addition,  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.
Oh, and one more thing,  E/M codes, are inherently flawed in general.  The rules required to meet their standards create an incredible inefficiency.  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  for the work provided.    You can see much more in my free lectures on coding in the hospital.  Make sure to also review my hospitalist resource center for a wealth of information on practice management.  


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2 Outbursts:

  1. Have you considered the additional training and level of sophistication involved in performing consultation services? The payment is not for time spent dictating or gleaning information, but for expertise. That is why you as a physician can be compensated better than someone without you training. Doesn't that make sense?

  2. I do consult codes too. Lot's of them in the hospital. Are you saying my time shouldn't be worth more as well?


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