AGA Washington Insider

A policy blog for GIs

Policy Eliminating Consultation Codes is in Effect

Just in case you were holding your breath hoping that CMS would delay the elimination of payment for the Consultation codes, you might want to start breathing and start implementing the new policy.  The policy, effective date-of-service Jan.1, 2010, has gone into effect and, though there are still efforts taking place to postpone the change for one year, we have not heard anything from CMS regarding a delay.  So here’s what you need to know:

  • Do not bill Medicare fee for service using either Outpatient or Inpatient Consultation codes (99241-99255) for services performed after Dec.31, 2009.
  • You can continue using the consultation codes for private payers unless they have notified you otherwise.
  • For Medicare patients seen in the office or other outpatient location other than the emergency room, use either a New Patient or Established Patient Visit (99201-99215).
  • New Patient Visit can only be billed if no one in your group of the same specialty has provided any service, in any location, for any reason to the patient within the last three years.
  • For services provided in the ER, use the Emergency Room codes.
  • For the first service provided to an inpatient during that admission, use the Initial Hospital Visit codes (99221-99223).  The documentation must support the code billed.  If you are the admitting physician, add an AI modifier to the code.  If the documentation does not support a 99221, use the Subsequent Hospital visit codes (99231-99233).
  • For follow-up visit to an inpatient during the same admission, use the Subsequent Hospital visit codes (99231-99233).
  • For a service provided in the Observation Unit, unless you are the admitting physician, use the Outpatient New or Established code (99201-99215), whichever applies.
  • Whatever code you use must be supported by the documentation as defined by the 1995 or 1997 Documentation Guidelines.

If you would like more information on the subject as well as guidance on how to calculate the financial impact of this change to your practice, and were otherwise occupied when we presented the Webinar on Dec. 22, 2009, you can listen to it  on-demand, purchase a CD  or read frequently asked questions online.

We will keep you informed of any changes to the current policy as they occur.

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