| As I stated in a previous posting, I have a | | | | established patients). Going forward, in the office |
| long-standing interest in Russian literature. | | | | environment, rather than considering a |
| Developing a love of the novels of Tolstoy and | | | | consultation code for patients referred to their |
| Dostoevsky requires a large amount of free time | | | | practice from another provider. the physician need |
| as well as a hearty concentration level. Yet | | | | only choose an E/M code based on whether the |
| possessing both of these things does not remove | | | | patient has been seen within three years of the |
| oneself from the fact that War & Peace, | | | | service date. |
| owing to its size, works better as a doorstop | | | | Selecting hospital services in the absence of |
| than most bricks. | | | | consultation codes will be a little trickier. CPT |
| Which brings me to the Final Rule for the 2010 | | | | codes 99221-99223, which in the past have been |
| Part B Physician Fee Schedule. Weighing in at | | | | used solely by the admitting physician, will now be |
| 1,669 pages, it was a lot to take in. Unfortunately | | | | used by all physicians upon their first encounter |
| for me, unlike War & Peace, there is no | | | | with the patient. In order to differentiate from the |
| corresponding movie to simplify and edit its | | | | admitting physician and other physicians providing |
| contents, yet onward I plunged. Many of the | | | | care to the patient, the admitting provider will be |
| changes were specific to services and specialties, | | | | required to add a modifier to his service signifying |
| but there were a few things that jumped out at | | | | that he/she is the admitting physician. The |
| me that I'd like to share with you. | | | | modifier to be used was not indicated in the Final |
| Beginning on January 1, 2010, consultation codes | | | | Rule, but should reveal itself upon release of the |
| (99241-99245 for office/outpatient, 99251-99255 | | | | 2010 HCPCS. |
| for inpatient) will no longer be reimbursed by | | | | One specialty reduction of interest affects |
| Medicare Part B. In the preamble to this portion of | | | | chiropractic services (CPT codes 98940-98942). |
| the Final Rule, CMS decided that after many | | | | These codes will be subject to a 2% reduction |
| years of attempts at education and clarification of | | | | beginning in January. |
| the rules for consultations, there remained mass | | | | For advanced imaging services such as nuclear |
| confusion as to the rules regarding consultation vs. | | | | imaging, CMS is now requiring that facilities |
| transfer of care, as well as widespread | | | | providing the technical component for these |
| documentation deficiencies and problems with | | | | services meet an accreditation standard in order |
| consultation code selection. | | | | to be reimbursed for these services. Of course, |
| To make up for the loss of revenue for | | | | the biggest adjustment in the Final Rule is the |
| consultation codes, There will be a 6% increase in | | | | CMS-projected 21.2% pay cut for physician |
| the RVU value on outpatient E/M services | | | | services. As in past years, this cut is expected to |
| (99201-99205 for new patients, 99211-99215 for | | | | be adjusted by Congress prior to the new year. |