The following is an excerpt taken from a paper done by Tom Darr, MD, Chief Medical Officer, Coding, Reimbursement and Payment Integrity at Ingenix.
“Effective January 1, 2010, the Centers for Medicare and Medicaid (CMS) will no longer pay for office/outpatient and inpatient consults identified by Common Procedural Terminology (CPT(R)) codes 99241-99245 and 99251-99255. In the January 2010 National Physician Fee Schedule (NPFS) these codes now have a status indicator of “I, Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code NOT subject to a 90 day grace period.).
Instead consulting physicians and, where appropriate, consulting non-physician providers (NPPs), will report the appropriate evaluation and management codes for their services solely on the basis of the existing rules and guidelines for the use of the relevant visit codes (for example, new or established office/outpatient visit [99201-99215], initial hospital care [99221-99223], or initial skilled nursing facility care [99304-99306]), without any reference to the guidelines that have been employed for the use of the consultation codes in the past.”
For a complete understanding of the ruling, the full document may be found in the “Doc” section, of your CareTracker dashboard (for those clients of ours using the CareTracker PM software), titled “Understanding CMS Final Rule on Consultation Services.
For those who are not a client or are not using CareTracker, click here to view the .pdf version of the document.
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