CMS Announces Changes for Physician Consultations in 2010
The Centers for Medicare & Medicaid Services (CMS) has announced payment policy changes for physician services to Medicare beneficiaries in 2010 which can be found in the October 30, 2009 issue of the Federal Register. CMS states:
The final rule with comment will appear in the Nov. 25, 2009 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.
Of particular concern to physicians has been the proposed change to eliminate use of consultation codes. CMS will no longer reimburse consultation CPT codes 99241 – 99245 and 99251 – 99255 effective January 1, 2010. Although the consultation codes will not be eliminated from the AMA CPT coding book, providers submitting claims with consultation codes for services provided to Medicare beneficiaries will be denied payment by CMS. Instead, new, established, and initial hospital visit codes should be utilized in lieu of consultative services provided in the office, hospital, or nursing facility.
For consultative services provided to patients in the hospital or nursing facility, physicians will bill an initial hospital care or initial nursing facility care code for their first visit during a patient’s admission to the hospital or nursing facility instead of the consultation codes physicians may have previously reported.
Primary care physicians for the initial hospital inpatient or nursing facility admission will continue to use the appropriate CPT codes with a modifier to identify the admitting physician of record. CMS will create this modifier for operational purposes to distinguish the admitting physician of record who oversees the patient’s care from other physicians who may be furnishing specialty care.
The admitting physician of record will be required to append the specific modifier to the initial hospital care or initial nursing facility care code which will identify him or her as the admitting physician of record who is overseeing the patient’s care. Subsequent care visits by all physicians and qualified NPPs will be reported as subsequent hospital care codes and subsequent nursing facility care codes.
Physicians providing telehealth consultative services will report using three new HCPCS codes.
Click here and select section Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B (for CY 2010)2009-26502for the complete PDF file.
For more detailed information regarding physician reporting of consultative services in 2010, please contact PYA at (800) 270-9629.
