CMS Eliminates Medicare Payment for Consultation Codes
CMS Eliminates Medicare Payment for Consultation Codes
Prepared by the UFJHI Office of Physician Billing Compliance
Outline
? Reasons for Change ? Effective Date ? New Modifier ? Impact on Other Payers ? Impact on Medicare
Secondary Claims ? Code Selection
? Office/Outpatient ? Inpatient Hospital ? Inpatient SNF/NF
? Global Surgery Allowance Changes
? Budget Neutrality and Fee Change Crosswalk
? Telehealth Consults ? Consult Coding
Conversion Chart ? Q&A
Prepared by the UFJHI Office of Physician Billing Compliance
Reasons for Change
? Divergent interpretations ? Lack of proper documentation to support consult code
(request, report) ? Continued lack of agreement or understanding of
Medicare policy despite numerous educational initiatives ? One of the two goals for development of new codes not panning out ? AMA CPT definition provides no clear definition of transfer of care and is ambiguous and confusing
Prepared by the UFJHI Office of Physician Billing Compliance
Reasons for Change
? Associated physician work for consult is clinically similar to other visits
? Written report not sufficient reason for higher reimbursement as all E/M services require documentation
? Preparation & submission of the consultant's report no longer major defining aspect of consultation but higher payment remains
Prepared by the UFJHI Office of Physician Billing Compliance
Effective Date
The changes are effective January 1, 2010
Prepared by the UFJHI Office of Physician Billing Compliance
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