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Nov./Dec. 2009
Vol. 19 No. 11
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Medicare in 2010: No More Payment for Consultation Codes; Possible Cuts Looming

Several changes are in store for Medicare in 2010—so many, in fact, that the Centers for Medicare and Medicaid Services (CMS) has extended the deadline for physicians to determine whether to participate in Medicare to Jan. 31, 2010.

To help IDSA members make that decision, IDSA has partnered with the American Medical Association (AMA) to develop a brief overview of the options. For more information, click here.

The biggest disappointment for ID physicians is the elimination of payments for inpatient (99251-99255) and outpatient (99241-99245) consultation codes, effective Jan. 1, despite vigorous opposition from IDSA and other specialty societies. CMS will allow physicians to bill initial inpatient consultative visits using the hospital admission codes (99221-99223), and follow-up care will continue to be billed using the subsequent hospital visit codes (99231-99233). The financial impact on an individual physician will vary, depending on his or her service mix.

Fortunately, Medicare will also increase the values for some Evaluation and Management (E&M) service codes, and ID physicians could also benefit from other, unrelated provisions in the Medicare fee schedule. Click here to see how the inpatient and outpatient consultation codes could be “cross-walked” to other E&M services.

Looming in the background, though, are potential, across-the-board physician payment cuts of 21 percent that will take effect Jan. 1 unless Congress acts. Congress forestalled previously planned cuts in 2008 and 2009, and physician groups are cautiously optimistic that these cuts also will be prevented, but maybe not before the new year. IDSA, AMA, and other medical societies are backing legislation that would permanently fix the Medicare physician payment problem as part of health reform. The measure passed the House of Representatives on Nov. 19, but Senate passage is less certain, given concerns about the price tag. See IDSA’s online Physician Payment Toolkit to learn how you can support this effort.

In addition, AMA in November adopted a resolution introduced by IDSA and 10 other medical associations that opposes efforts to eliminate payments for inpatient and outpatient consultation codes by either public or private payers. The AMA resolution also supports legislation to overturn the recent CMS action. IDSA also recently wrote a letter to Health and Human Services Secretary Kathleen Sebelius strongly opposing the CMS decision and urging a delay.

IDSA continues to monitor Medicare payment issues, and is developing new billing and coding resources for IDSA members, particularly related to consultations. Check the Billing and Coding Resources page of the IDSA website in late December. (You must be logged in to access this page.)
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