Urology Coding Alert

Come Jan. 1, you may have multiple ways of reporting your doctor's services.

CPT Codes did not eliminate the consultation codes, which could be troublesome for your coding know-how.

"CPT still recognizes the codes, and they will be in the 2010 CPT book," says Leah Gross, CPC, coding lead at Metro Urology in St. Paul, Minn. "Medicare is just not recognizing them. So far, we haven't been able to get word from any other insurance," she adds.

Some large payers and perhaps also small payers that do not base their fee schedules on Medicare's fee schedule may not follow Medicare's lead. As of mid-December, directives still remain unsettled. 

The potential for differing rules between CMS and private payers, could spell trouble. "We are going into Dante's Inferno for 2010," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions and Senior Coder and Auditor for The Coding Network. "We will have to manage who does and who does not allow consultation codes." Each payer may decide at will to reject or to accept 99241-99255.

One payer's plan: At the AMA CPT and RBRVS 2010 Annual Symposium in Chicago, a medical director indicated that at least one payer will continue to use consult codes. "Blue Cross Blue Shield of Rhode Island will accept either method," said Peter A. Hollmann, MD, the AMA CPT editorial panel, vice chair in his "Evaluation and Management" presentation at the AMA symposium. "I'm not sure how helpful our decision will be for you considering how big a state Rhode Island is," Hollmann joked with attendees.

BCBS RI made this decision for two reasons:

"We wanted to allow physicians to report based on both CMS and CPT rules," Hollmann explains.

And the contractor is not using the 2010 fee schedule because it can't implement the changes by Jan.1, 2010, Hollmann reported. "Since we're not redistributing the relative value units" to pay more for office visits and hospital care services in exchange for invalidating consult codes, "we won't change our consult policy."