The Centers for Medicare and Medicaid Services has released its final 2010 Physicians Fee Schedule. One of the most significant changes was the elimination of payment for inpatient consultation codes as of January 1, 2010.

This does not mean you can no longer do consulting work, it just means that you will have to bill these procedures differently than you do now. Here are the facts regarding this new ruling and the potential impact on your practice.

1. Consulting codes 99241-99245 (outpatient/office) and 99251-99255 (inpatient) have been eliminated effective January 1, 2010. Telehealth consultation G-codes (G0425-G0427) will not be eliminated.

2. Starting January 1, 2010, CPT codes for new (99201-99205) or established (99211-99215) patients should be used to replace consultations in the office/outpatient setting.

3. Starting January 1, 2010, CPT codes in the inpatient hospital setting (99221-99223) should be used to replace inpatient consultation codes (99251-99255), and for nursing facility consultations use codes (99304-99306).

4. To distinguish the difference between the admitting physician of record from the consultants for initial hospital inpatient and nursing facility admissions, CMS will develop a modifier. Currently, modifier “AI” is for principal physician of record; however Medicare has not finalized the modifier to be used for consulting.

5. Medicare states that its changes are budget neutral. RVUs for all E/M codes have been increased in an attempt to offset the fees lost from the elimination of consulting codes. The increase in E&M payments is approximately 6% for outpatient/office codes and 2% for inpatient codes above 2009 levels.

Private insurers are another story. No information has been released by other third party payers regarding payment for consulting codes codes as of yet. However, if a 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 consulting claim filed with a commercial insurer such as Blue Cross or Aetna who is primary using the eliminated consultation codes when Medicare is secondary would result in a denial for the secondary claim by Medicare. In those instances where Medicare is secondary, you will need to follow the guidelines from above.

Another note. If you have not updated your enrollment information with CMS since November 2003, you must do so by April 5, 2010. Although enrolled in Medicare, many healthcare providers 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 record is one that is in the Medicare provider enrollment, chain and ownership system (PECOS) and also contains the doctor’s national provider identifier (NPI).

For important info about Internet Marketing Manuals – go through the web site. The time has come when proper info is really only one click of your mouse, use this possibility.

Technorati Tags: Amp, Centers For Medicare And Medicaid, Centers For Medicare And Medicaid Services, Cms, Consultations, consulting codes, Cpt Codes, Hospital Inpatient, Inpatient Hospital, January 1, Medicaid, Medical Consultation, Medicare, Medicare And Medicaid, Medicare Medicaid, Nursing Facility, Party Payers, Private Insurers, Rvus, Secondary Payer, Setting 3