Medicare Eliminates Consultation Codes
The Centers for Medicare and Medicaid Services (CMS) has eliminated the use of most existing consultation CPT and HCPCS codes for original Medicare Part B.
This included inpatient codes 99251 to 99255 and outpatient/office codes 99241 to 99245. Instead of using consultation codes, providers should bill, as applicable:
- Initial inpatient hospital care: 99221 to 99223
- Subsequent hospital care: 99231 to 99233
- Initial nursing facility care: 99304 to 99306
- New patient office visit: 99201 to 99205
- Established patient office visit: 99211 to 99215
Learn more about how private payers plan to use consultation codes in 2010.
To distinguish admitting physicians from consulting physicians who will also be using initial hospital care codes, CMS has created an "AI" modifier to be used by the admitting physician. The admitting physician will append the modifier to the initial care code, which will identify the physician as the admitting provider of record.
Other physicians will bill the applicable initial care code without a modifier when a patient is seen for the first time during that hospital admission.
For office consultations, physicians should now bill either a new patient visit code if the patient meets new patient criteria or an established patient visit code if they do not meet new patient criteria (for example, if the patient was seen sometime in the last three years).
As part of this change, CMS increased work relative value units (RVUs) for initial hospital and nursing facility visits by about 3 percent and increased work RVUs for both new and existing office visit codes by approximately 6 percent. There also was a nominal increase in work RVUs for surgical services with a 10- or 90-day global period.
In addition, documentation requirements for consultations are no longer applicable for Medicare.
For inpatient and office visits, physicians must meet the applicable evaluation and management (E&M) coding and documentation requirements for new and established office visit codes and initial and subsequent hospital visit codes.
Medicare will not convert billed consultation codes to the appropriate office or inpatient codes. Claims using consultation codes will be rejected.
CMS has provided more information in change request 6740.
Last Updated: 4/1/2010