June 14, 2010
Some Private Payors Changing Consultation Code Payment Policies
In response to Medicare's decision to no longer recognize inpatient and outpatient consultation codes, some private payors have also made changes to their consultation code payment policies. Under the new Medicare rules, effective January 1, 2010, physicians must instead bill using E&M codes from the Office and Other Outpatient Services, Initial Hospital Care, and Initial Nursing Facility sections of the 2010 CPT.  CMA has published a Managed Care Consultation Code Quick Reference Guide, detailing which major payors in California will be changing their payment policies.

Click here to access the Managed Care Consultation Code Quick Reference Guide.


Feb 17, 2010
Consultation Code Issue Frustrates Physicians; CMA Publishes Updated Billing Guide
Despite strenuous objections from CMA and others in organized medicine, Medicare will no longer recognize inpatient and outpatient consultation codes. Effective January 1, physicians must instead bill using E&M codes from the Office and Other Outpatient Services, Initial Hospital Care, and Initial Nursing Facility sections of the 2010 CPT. While CMS has increased the work RVUs for new and established office visits, as well as initial hospital and nursing facility visits, these changes may result in significant losses for some practices.

CMA has published a 4-page billing guide that includes an overview of the issue, a code crosswalk, and links to additional resources. Physicians who use a third party billing service are also urged to call their vendors to make sure that they are aware and prepared for this rule change. CMA is also surveying major payors in California to find out which of them plan to follow Medicare's lead and eliminate use of consultation codes. Once we have gathered this data, we will make it available to members.  In addition, an archive of the ACCMA webinar "Medicare Hot Topics 2010", which provides guidance on coding for consultations using E&M codes, is available for $25 from the ACCMA website under "Seminars & Webinars."

For the CMA bill guide click here.