News from the AOA's Blog

Effective January 1, 2010, consultation codes (99251-99255, 99241-99245) will no longer be recognized on claims for Medicare Part B payment, according to the U.S. Centers for Medicare & Medicaid Services (CMS).

Physicians should now report patient evaluation and management visits using appropriate E/M codes that indicate where the visit occurred and the complexity of the services performed, the agency stipulated in a Dec. 14 advisory to carriers.

The policy change eliminates the use of all inpatient and office/outpatient codes for various places of service except for telehealth consultation G-codes, the agency said.

When an evaluation is performed in the office or other outpatient setting, physicians and qualified nonphysician practitioners should use the CPT Office or Other Outpatient Service codes (99201 – 99215) depending on the complexity of the visit and whether the patient is a new or established patient to that physician, the CMS advised.

Rural health centers and federally qualified community health centers should use E/M codes 99201-99215 or 99304-99306.

Consultation codes are being eliminated from the Medicare Part B coding system under the Medicare 2010 Physician Fee Schedule Final Rule. The coding change was accomplished in a budget neutral fashion with funding that would have been used for payment of consultation codes to now be used in paying for other approved services. Relative values for E&M services have been increased.

The CMS informed carriers of the coding policy change with Medicare Claim Processing Change Request 6740 which can be accessed on the CMS Web site (www.cms.hhs.gov/transmittals/downloads/R1875CP.pdf).

The CMS emphasizes that all E/M services should be reported in line with Medicare E/M documentation guidelines which can be accessed at www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp.