As you may be aware, most payers no longer recognize or reimburse the consultation code series 99241-99255.  This began with Medicare Part B on 1/1/2010.  Additionally, there are other reasons for eliminating the consult codes which are listed below:

  1. The number of insurance carriers now accepting consult codes is minimal.
  2. By eliminating the consult codes from all EPIC processes, we will be eliminating any billing and potential auditing complications.

 

Impact:

An RVU analysis was done and the impact is MINIMAL to the overall values (less than 1%).   Please know that in 2010, in conjunction with the elimination of all consultation codes [except telehealth consultations], CMS increased the wRVUs for new and established office visits and for initial hospital and initial nursing facility visits.  CMS also increased the incremental work RVUs for the evaluation and management (E/M) codes that are built into the 10-day and 90-day global surgical codes

 

Q:  I currently use Consult Codes (99241-99255).  What do I use starting Monday, June 4th?

 

  1. For inpatient encounters, McKesson will continue to code those encounters (a modifier is used to distinguish the attending physician from other physicians furnishing specialty care).

 

  1. For outpatient visits, including observation services, which formerly were “consults”, the new or established outpatient (99201-99215) series would be selected.  Follow-up visits in the facility setting may be billed as subsequent hospital care visits and subsequent nursing facility care visits as is the current policy. In all cases, physicians shall bill the available code that most appropriately describes the level of the services provided.

 

Epic Changes:  Consult Codes 99241-99255 will be removed from the LOS Section of an encounter.  The codes will also be removed from any SmartSet that contained an LOS Consultation Section.

Please note that the Epic process for placing an order for a consult/referral remains unchanged.  As is good medical practice, we still recommend documentation of the referring provider in the chart as well as initiating correspondence with the referring provider to relay your expert opinion.

 

 

For any questions, please email Dr. Snehal Gandhi at gandhi-snehal@cooperhealth.edu

Elimination of Consult E&M Codes in Epic

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