The Federal Register has published the Medicare Physician Fee Schedule Final Rule for 2010 and has eliminated the use of consultation codes for Medicare services.  As stated  in the proposed rule, CMS maintains the position that consultation codes are subject to far too much disagreement on guidelines and implementation to continue permitting physicians to bill them. 

The good news:   In an audit scenario, at least going forward, the omission of these consultation codes will minimize the commonly encountered risk of denials.  The bad news:  This change could have a negative impact to specialty physician compensation based on work RVUs as well as to overall Medicare reimbursement unless your practice is heavily weighted toward inpatient and nursing facility care. 

In order to implement this change in a budget neutral manner, Medicare will increase the work RVU value by 6% for new and established office patient visits and 2% for initial and subsequent hospital visits.  Cross walking the consultation codes to appropriate substitute codes reveals losses of work RVU value in new and established patient visits as well as level three hospital admits and nursing facility care (99201 thru 99205 and 99223 and 99306) and gains in levels one and two hospital admit visits and nursing facility care (99221, 99222, 99304, 99305).  Gain by any physician will likely be negated if Congress does not pass a bill to stop the 21.2% decrease to the conversion factor that is scheduled this year. 

Stay tuned for the admitting physician modifier that CMS plans to release for initial inpatient and nursing facility codes as well as the reaction by Medicaid and non-governmental payers.  Until notified otherwise, continue to bill payers other than Medicare with the consultation codes in 2010.

Author: Valerie G. Rock, CPC, ACS-EM (vrock@gatesmoore.com)