PA Practice Insight: Prepare for the Demise of Consult Codes

The in-patient and office consult codes are a thing of the past at CMS, and it remains to be seen whether any private carriers will also discontinue the codes. In its final rule for 2010 issued in October, CMS said Medicare will no longer recognize the codes and advised practices to instead use the new and established office visit or inpatient hospital codes.

In comments submitted to CMS on behalf of the American Academy of Dermatology Association (AADA), Association President David Pariser, MD, “challenged the assertion that as CMS has relaxed documentation requirements for consultations there is truly a reduction in physician work. In light of efforts underway attempting to improve coordination of care among primary care physicians and specialists, this seems like an important opportunity to incentivize thorough communication.”

Furthermore, Dr. Pariser identified potential “coding inequities with the elimination of the consultation codes,” particularly for specialists who practice within multispecialty groups. If a physician in a multi-specialty group sees a new patient who has already been seen by another primary care or specialist physician within that group practice within the last three years, that patient—who would have been billed as a consult when those codes were active—will now be billed as an established patient visit, “even though the physician work required would be the same as a new patient visit,” Dr. Pariser notes.

All providers within dermatology are encouraged to review the changes and re-evaluate the requirements for new and established patients to ensure that all billings reflect the appropriate level of service.