The goal: Eliminate confusion over transfers of care. Dig Into the Details of the Proposal In the July 13 Federal Register CMS announced a proposal to eliminate consultation codes starting on Jan. 1, 2010. The plan includes the elimination of all inpatient (99251-99255, Inpatient consultation for a new or established patient ...) and outpatient (99241-99245, Office consultation for a new or established patient ...) consultation codes. This change would "result in a net decrease in allowed charges of approximately $1 billion, which we are proposing to bundle back into the initial hospital care visits and initial nursing facility care visits," stated CMS's Whitney May during a July 9 CMS Open Door Forum. "Payment for these visits would also increase, depending on how we account for the practice expense associated with a consult." Good news: "There has been much confusion about consultations in general. When is a patient a transfer of care as opposed to a true consultation?" says Suzan Berman (Hvizdash), CPC, CEMC, CEDC, senior manager of coding and compliance with the UPMC departments of surgery and anesthesiology in Pittsburgh. "I think [the change] will put an end to the confusion for consult versus transfer of care," adds Collette Shrader, CCP-P, in the compliance/education department of Wenatchee Valley Medical Center in Washington. "I think it will make the coders' and auditors' lives easier." New way: To make up for the elimination of the consultation codes, CMS will allow more than one initial hospital visit or initial nursing home visit, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, senior coder and auditor for The Coding Network, and president of CRN Healthcare Solutions. Private payers: Could Another Modifier Be in the Works? According to the proposal, CMS plans to create an additional modifier for the admitting physician to append to the initial hospital visit codes. "Because of an existing CPT coding rule and current Medicare payment policy regarding the admitting physician, we will create a modifier to identify the admitting physician of record for hospital inpatient and nursing facility admissions. For operational purposes, this modifier will distinguish the admitting physician of record who oversees the patient's care from other physicians who may be furnishing specialty care," the Federal Register says. The benefits: If the physician's documentation was not done properly you were unable to bill a consultation code; however, a subsequent visit code did not appropriately reflect the service your surgeon rendered, she adds. Plus, if your physician was seeing a patient for an underlying condition, you couldn't properly identify the first visit either, Berman laments. "Now, with this modifier (if it comes to fruition), there will be truer reporting of the services being done for the patient," she says. "All will know who the admitter was and who saw the patient thereafter." Caveat: Other potential changes: