One of the most essential changes for Medicare billing recently is the elimination of payment for consultation codes. Your practice will have to adjust how you bill for these types of services or you will find a lot of denials.
Just in case you have not had a occasion to read the newly released fee program (just kidding, it is a lot to read), I have summarized the section on consulting codes below.
Here are the facts with regard to this new ruling and the possible impact on your practice.
1. Consultation codes 99241-99245 (outpatient/office) and 99251-99255 (inpatient) have been eliminated. Tele-health consultation G-codes (G0425-G0427) will not be eliminated.
2. Use codes for new (99201-99205) or established (99211-99215) patients to replace consultations in the office/outpatient setting.
3. Codes in the patient hospital setting (99221-99223) should be used to replace patient consultation codes (99251-99255), and for nursing facility consultations use codes (99304-99306).
4. To distinguish the inequity between the admitting doctor of report from the consultants for first hospital patient and nursing facility admissions, Medicare will establish a modifier. Check with your local carrier for more information.
5. Payments for all estimation and management codes have been increased in an endeavor to offset the fees lost from the elimination of consultation codes.
An foremost note with regard to commercial or private insurance. No data has been released by other third party payers with regard to payment for consultation codes as of yet. However, if your patient has Medicare as a secondary payer, a decision will need to be made by the doctor as to how you will report the consultation. Any consultation claim filed with a commercial insurer such as Blue Cross or Aetna who is customary using the eliminated consultation codes when Medicare is secondary would corollary in a denial for the secondary claim by Medicare. In those instances where Medicare is secondary, you may want to think using the new guidelines as stated above for reporting consultation codes.
One more note. If you have not updated your enrollment data with Medicare since November 2003, you must do so. Although enrolled in Medicare, many physicians who are eligible to refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment report is one that is in the Medicare victualer enrollment, chain and proprietary ideas (Pecos) and also contains the physician's national victualer identifier (Npi).
Follow these few simple guidelines and you should have no problem being paid for consulting codes.
Medicare Eliminates Consult Codes - What Now?
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