Medical Staff

Will Medicare coding changes help or hurt hospitalist program revenue?

Medical Staff Briefing, March 1, 2010

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Since the Center for Medicare & Medicaid Services (CMS) announced in October 2009 that it will no longer pay for inpatient or outpatient consultation codes starting in January, the hospitalist community has been aflutter with questions. One of the biggest questions is whether the coding changes will affect hospitalist revenue. HLA spoke with two industry experts to answer this question.

First, it is important to understand the changes that CMS has imposed on current procedural terminology (CPT) codes. The regulator has eliminated five inpatient consultation codes (99251-99255). This leaves three initial hospital care codes (99221-99223), three subsequent hospital care codes (99231-99233), and two discharge management codes (99238 or 99239).

As of January 1, regardless of whether a hospitalist cares for a patient he or she admitted or serves as a consulting physician, the hospitalist must submit either an initial hospital care code or a subsequent hospital care code. (Admitting physicians must include the modifier AI to distinguish themselves from other physicians caring for the same patient.)

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Medical Staff Briefing.

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