New rule means simpler coding, but less pay. Get Ready for Lower Pay -- Maybe • CMS will increase the work relative value units (RVUs) for new and established patient visits by 6 percent. • CMS will increase the work RVUs for initial and subsequent hospital visits by 2 percent. • The increases are positive on the surface, but might not be in real life. "Obviously, this will result in an income increase for primary care specialties and a decrease for specialists who use consult codes," Nicoletti says. "The difference between a new patient visit and a consult was far greater than 6 percent." "I think the determination of whether this is a potential win or loss situation would be very dependent on individual provider reporting patterns," says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC. "It could potentially hurt more when an established patient is sent to a physician for consultation on a new condition. Instead of reporting a consult code (9924x), the physician will be forced to report an established patient visit (9921x), and that will be a big kick in the wallet." Office E/M Codes Cover Bases Now Once the new rule goes into effect, code your Medicare claims based on the setting and beneficiary's status. When your physician sees a patient in an office or outpatient setting, choose from 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...). "That's fairly straightforward, as long as you remember the definition of a new patient," Nicoletti says. Definition: Someone could mistakenly select 'new' when the patient is actually 'established,' so be careful of that." Hospital Visit = 2 Sets of Codes Code for an initial hospital service with the appropriate choice from 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...) -- what Nicoletti says many physicians and other healthcare providers persist on calling "admissions." Coming later: All physicians will report subsequent visit codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) for follow-up inpatient care. Wait for Reaction From Other Payers Whether other payers will follow CMS's lead regarding consultation coding remains to be seen. "The consult codes are in the CPT 2010 book, with new commentary about transfer of care," Nicoletti says. "We'll have to query our commercial payers individually to ask if they are changing their policies." In the meantime, prepare to play by two sets of rules, depending on whether you're filing with Medicare or another payer. Another consideration: Answer: