Urology Coding Alert

Although CMS has proposed halting payment for the in-office consultation codes (CPT 99241 -CPT 99245 , Office consultation for a new or established patient ...) and inpatient consultation codes (99251-99255, Inpatient consultation for a new or established patient ...) in 2010, the AMA chose not to delete them, keeping them in the CPT manual for another year. Here's how your practice will be affected.

The fact that the consult codes appear in CPT 2010 does not mean payers will actually cover the services next year. In fact, Medicare published the final rule on the fee schedule and adopted the proposal to no longer pay for the consultation codes. Private payers may also follow suit and eliminate consultation payment.

"We will have to watch other payers for what they are going to do regarding consultations," says Amanda S. Stoltman, CCS-P, compliance coder at Urology Associates in Muncie, Ind. "Medicare is, so far, the only payer that has made the decision not to pay for consultations. That said, the codes as defined in the CPT book will still have to be utilized according to CPT regulations, just for Medicare we have to ignore the consultation rules and regulations."

"The problem is that the elimination is only a CMS issue and not a private payer elimination and may be done at will by each payer or may not," explains Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J., and senior coder and auditor for The Coding Network. "AMA has kept consultations in the CPT manual and we will have to manage who does and who does not allow consultation. If you think getting a request for opinion was hard before, this will be worse, since no one knows who will require one, with the only surety being that CMS does not."

Impact: Practices will have to re-educate physicians, nonphysician providers, coders, CMAs (certified medical assistants), nurses, and secretaries and will need to revise their encounter forms, says Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind.

More information: You can review the final rule at www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf. Watch for information on the 2010 Medicare Physician fee schedule in future issues of Urology Coding Alert.