OMG!!! CHANGES, CHANGES, CHANGES!!!!!

Quick... Hold on tight, as the changes for 2010 in CPT are coming in fast and furious. I had some GREAT e-mail and updates from my Friends @ PHIA to help us through the murky "consultation" issues for 2010. In addition, they have GRACIOUSLY allowed me to link and forward this info to you! (THANK SO MUCH NICKY AND SHERRY!)


This is direct from the PHIA "newsflash"

In the calendar year 2010 physician fee schedule final rule with comment period (CMS-1413-FC) CMS budget neutrally eliminated the use of all consultation codes for various places of service except for telehealth consultation G-codes. Effective date of change is January 1, 2010, with implementation to begin on January 4, 2010.

http://www.cms.hhs.gov/transmittals/downloads/R1875CP.pdf Click on this link (or cut/paste into your browser) to see the entire transmittal : )

·CMS increased the work relative value units (RVUs) for new and established office visits, increasing the work RVUs for initial hospital and initial nursing facility visits, and incorporating the increased use of these visits into our practice expense PE and malpractice calculations.

·In the inpatient hospital setting and the nursing facility setting all physicians who perform an initial evaluation and management may bill the initial hospital care codes (99221 – 99223) or nursing facility care codes (99304-99306). As a result of this change, multiple billings of initial hospital and nursing home visit codes could occur even in a single day.

·Modifier “-AI,” defined as “Principal Physician of Record,” shall be used by the admitting or attending physician who oversees the patient’s care

·In the office or other outpatient setting where an evaluation is performed, physicians and qualified nonphysician practitioners shall use the CPT codes (99201 – 99215) depending on the complexity of the visit and whether the patient is a new or established patient to that physician. These rules are applicable for Medicare secondary payer claims as well as for claims in which Medicare is the primary payer.

·Contractors must advise physicians that to bill the highest levels of visit codes, the services furnished must meet the definition of the code (e.g., to bill a Level 5 new patient visit, the history must meet CPT’s definition of a comprehensive history).

·The comprehensive history must include a review of all the systems and a complete past (medical and surgical) family and social history obtained at that visit. In the case of an established patient, it is acceptable for a physician to review the existing record and update it to reflect only changes in the patient’s medical, family, and social history from the last encounter, but the physician must review the entire history for it to be considered a comprehensive history.

·When a physician performs a visit that meets the definition of a Level 5 office visit several days prior to an admission and on the day of admission performs less than a comprehensive history and physical, he or she should report the office visit that reflects the services furnished and also report the lowest level initial hospital care code for the initial hospital admission. Contractors pay the office visit as billed and the Level 1 initial hospital care code.

·Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes.

·For example, if an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial observation care code. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate.


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IN ADDITION..... MORE INFORMATION!

One thing to keep in mind when billing out services with the new AI modifier is that this modifier is specifically for use with Medicare/Medicaid claims. If you are billing to a private payor, you will want to find out if the payor recognizes this modifier.

Consultation codes are still a valid code within CPT, but do not have RVU's associated with them. You will also need to check with your private payors to see if they will continue to recognize the consultation codes, and pay you for them. If they do, be sure to follow all CPT guidelines for usage of the consultation codes.

Consultation Changes for 2010

Happy Holidays... Not much may change for me here in Idaho, but in the world of coding... things are changing fast and furious..... Below is a quick "down and dirty" of the changes that are on the horizon for the 2010 consultations. This came to me by way of Gail Eldridge (Coding Goddess extraordinaire!) so I am sharing with all of my Blogging friends! E-mail me if you have ??'s or concerns... networking is one of the best ways to problem solve!!! Enjoy your holiday and keep on coding!


What's Coming for Consultations in 2010

There are some major changes to inpatient consultation codes coming Jan.1st, 2010. Unfortunately I still have unclear guidance on exactly what the changes will mean to you. Stay tuned next month for more information

What we do know

- As of January 1st, 2010 Medicare will no longer pay for the inpatient or outpatient consultation codes (99241-99245 and 99251-99255)

- Outpatient consultations will be billed with the new patient E&M codes (99201-99205)

- Inpatient consultations will be billed with either an Initial hospital Care code(99221-99223) or a subsequent hospital care code (99231-99233)

- Medicare will now pay for more than 1 provider to bill the Initial hospital care code (99221-99223) multiple specialties will now be able to bill this code

- An unknown modifier will need to be appended to the Initial hospital care code(99221-99223) of the admitting physician

- Work RVU values will be increased for new patient E&M codes (99201-99205) and Initial hospital and subsequent hospital care codes (99221-99223 and 99231-99233)

- The 2010 CPT description of the consultation codes actually loosens the language of when you can bill a consultation. New language states "recommend care or assume ongoing management" it also states that the request for the consult can now be documented by the requesting or the rendering provider

- Telemedicine consultations will still be paid with the appropriate G-Codes


What we don't know- We have no idea which other payors will be paying for these codes if any or what RVU value will be assigned. It is suspected that several Idaho payors may continue to allow use of the inpatient and outpatient consultation codes

- The only payor that has announced they will pay for the consultation code set is on the east coast with no active members in Idaho

The "infamous" Christmas Letter.........

Yes..... It's that dreaded Christmas "letter"! So pour yourself a BIG glass of your favorite wine and settle in for lots of bragging. (I do have the cutest grandson EVER!!!) Oh yeah, and I didn’t win the lottery. ha ha ha...

Not much changes here @ our place in Idaho, so I really don't have a lot to "update" you on. So to spare you the gory details, and not bore you outta your mind... I'll just wish you a

VERY MERRY CHRISTMAS, and a BLESSED NEW YEAR.

Remember to say "I love you" to your family, friends, and all the wonderful people that we have in our lives. May God help you "fill in your dash" with the things that make you happy!

Oh, Yeah…..about that glass of wine…. Celebrate and toast to a really good 2009 and to the promise of 2010.


Love Always...

Lori-Lynne