What is the medical billing code, 99213

Sales of specialists decrease due to the elimination of consultation codes

July 21, 2010 - Medical specialists such as neurologists, cardiologists, gastroenterologists and psychiatrists have made a significant cut in Medicare salaries this year - for some by as much as 15% - unrelated to the so-called "Doc Fix" in Congress according to a survey by the American Medical Association and 17 other medical societies.

Rather, this is due to the decision of the Centers for Medicare and Medicaid Services (CMS) to delete the billing codes for outpatient and inpatient consultations from January 1, 2010, which specialists once circled on fee tickets with another doctor - usually a primary care provider have colleague - referred a patient to him for comment. Now specialists are supposed to select low paid codes for regular inpatient or office visits, which, together with consultations, represent types of evaluation and administrative services.

There were once separate billing codes for consultations in a doctor's office compared to those in the hospital. Both code sets apply to either new or established patients, which is also the rule for regular inpatient visits. In contrast, CMS uses separate sets of billing codes for new and established patients when it comes to regular office visits.

In 2009, a specialist was able to select a billing code of 99243 for an office consultation of moderate complexity that provided $ 124.79 for the Medicare fee schedule. In contrast, the Medicare allowable amount was $ 91.97 for a regular office visit of moderate complexity for a new patient (99203) and $ 61.31 for a regular office visit at the same level for an established patient (99213).

CMS justified the removal of consultation codes by stating that the necessary documentation requirements for such visits were not sufficiently differentiated from the work required for ordinary stationary or office-based evaluation and administrative services. So there was no compelling reason to pay more for consultations.

The agency also found a study that reported that 19% of visits billed to Medicare as consultations did not meet the definition of that service. Sometimes, when a GP turns a patient's care to a specialist instead of getting a one-off opinion, the specialist mistakenly codes the first visit as a consultation, as opposed to a poorly paid visit from a new patient.

CMS took the money saved by eliminating the lucrative consultation codes, increasing prices for office visits involving new and established patients, as well as initial inpatient visits. When CMS proposed this mix of funds, it acknowledged that family doctors would generate income at the expense of specialists. However, the agency predicted that according to organized medicine, no specialty would see sales decline more than 3%.

The survey of medical societies published on July 16 shows that the loss of income for specialists was lower than 3%: Of the approximately 5,500 doctors who took part in the survey, approximately 7 in 10 said that the loss of the consultation codes meant that their total income was lost has decreased by more than 5% and 3 in 10 reported decreases of more than 15%. As a result of these cuts, 20% of physicians surveyed are admitting fewer new Medicare patients and 11% have reduced visits to them. In addition, 39% are delaying purchases of new equipment and medical software, and 34% are reducing staff.

Disgruntled executives were quoted by medical specialists in a press release announcing the survey results.

"By removing counseling service codes, CMS is declaring that the training and unique specialty care provided by rheumatologists are not valued," said Dr. Stanley Cohen, President of the American College of Rheumatology.

Scott Tenner, MD, chairman of the National Affairs Committee of the American College of Gastroenterology, added, "For those with digestive problems, the effects of eliminating consultation codes could make it difficult to find a [gastrointestinal] specialist."

Specialists write fewer recommendation reports

The medical societies also contend that the decision to discard consultation billing codes undermines coordination of care. To justify the use of a consultation code before 2010, a doctor had to send the referring doctor, among other things, a written report of the encounter with the patient. Approximately 6% of physicians surveyed said they no longer provide these reports to Medicare patients, and another 19% plan to follow suit.

In a June 18 letter to CMS, the American Medical Association and 33 other medical societies suggested that the agency might find a way to reimburse specialists for preparing these reports

The Organized Medicine letter to CMS cites other issues with Medicare's reimbursement policy. One of these is the ability of a doctor - such as a counselor - to be paid for the total time he or she devotes to a patient with an evaluation and management code for extended periods of service. According to medical societies, this doctor is entitled to count the minutes he has spent in a hospital, reviewing records and speaking with the patient's relatives and caregivers, in addition to the time he has spent personally with the patient Has. With CMS, however, the doctor can only bill the face time.

"In fact, Medicare is refusing to pay for these (non-personal) services, making it even more difficult to coordinate care between professionals," the companies said in their letter.

Another fly in the ointment is a new patient's CMS definition. In the past, when specialists charged for consultations, they did not have to distinguish between new and established patients. You must do this now when choosing an office visit evaluation and management billing code. However, patients who are considered new to organized medicine are sometimes classified as established by CMS, which translates into lower fees.

In their letter to CMS, the medical societies asked the agency to consider revising their guidelines for both long-term visits and new patients.