You can speak out on codes for consultation

November 5, 2010

The elimination of reimbursement for consultation codes has impacted physician revenue greatly, in some instances. Learn how to address this in your practice.

Key Points

A: This question is on the minds of many physicians and physician groups across the country.

Although the Centers for Medicare and Medicaid Services (CMS) minimally increased the work relative value units (RVUs) this year for evaluation and management office visits (99201–99215), initial nursing facility visits (99304–99306), and initial hospital visits (99221–99223), the net result is a loss of revenue for specialty practices, which could lead to serious patient care issues also affecting primary care physicians (PCPs).

The survey revealed several cost-cutting steps being taken by doctors:

"These are real-world examples of the impact of this policy change on Medicare patients and physician offices in the medical specialties that participated in the survey," according to a statement by the AMA.

J. James Rohack, MD, the organization's immediate past president, added that "patient health is best managed when physicians can work together across specialties to coordinate care. Twenty percent of patients over age 65 live with 5 or more chronic illnesses, and managing their care frequently requires PCPs to consult with a physician who specializes in the medical or surgical care of their conditions. The new CMS policy of eliminating Medicare consultation codes fails to adequately recognize the additional time and effort involved in these consultations and limits physicians' ability to work together as a comprehensive healthcare team for their patients."

As you can see, you are not alone in your concerns regarding the far-reaching impact of the elimination of consultation codes by CMS. Although the aforementioned cost-cutting steps will affect care for all patients-whether or not their care is covered by Medicare-they may become increasingly necessary if CMS does not change its decision to reimburse for consultation codes or increase the work RVU reimbursement for office visits and initial inpatient and nursing home codes.

After the survey, the AMA and 33 other medical groups created a letter (http://AMA.pr-optout.com/Url.aspx?13801x1086079x3951) outlining their concerns and asking CMS to reconsider its current policy so that care coordination between physicians can be improved. If you would like to send a letter detailing your concerns, you may direct it to:

Marilyn Tavenner
Acting Administrator, CMS
Hubert H. Humphrey Building
200 Independence Ave. SW
Washington, DC 20201

The author is a medical consultant based in Indianapolis, Indiana. Do you have a primary care-related coding question you would like to have our experts answer in this column? Send it to medec@advanstar.com