Health Information Management

Healthcare News: CMS issues special edition Q&A about reporting physician consultation services

JustCoding News: Outpatient, March 10, 2010

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On March 1, CMS released MedLearn Matters Special Edition Article SE1010, “Questions and Answers on Reporting Physician Consultation Services,” for physicians and non-physician practitioners who perform initial evaluation and management (E/M) services, previously reported with CPT® consultation codes for Medicare beneficiaries.

This article pertains to change request (CR) CR6740, which alerted providers that as of January 1, Medicare no longer recognizes consultation codes 99241–99245 and 99251–99255.

SE1010 includes dozens of Q&A. Consider the following example:

Q. Is CMS going to crosswalk the CPT consultation codes that are no longer recognized to the E/M codes for each setting in which an E/M service that could be described by a CPT consultation code can be furnished?

A. No, providers must bill the E/M code (other than a CPT consultation code) that describes the service they provide in order to be paid for the E/M service furnished. The general guideline is that the provider should report the most appropriate available code to bill Medicare for services that were previously billed using the CPT consultation codes. For services that could be described by inpatient consultation CPT codes, CMS has stated that providers may bill the initial hospital care service CPT codes and the initial nursing facility care CPT codes, where those codes appropriately describe the level of service provided. When those codes do not apply, providers should bill the E/M code that most closely describes the service provided.

Consequently, CMS revised MedLearn Matters article MM6740, “Revisions to Consultation Services Payment Policy,” to clarify language in the original CR and to add a reference to MedLearn Matters article SE1010. All other information remains the same. 

To read the Q&A in its entirety, access SE1010.

To read the revised article, access MM6740.

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