Plastic Reconstructive Surgeons New Rules

How CMS’ new rules regarding consults will affect the way Plastic and Reconstuctive Surgeons bill for office and hospital visits to patients in the Emergency Department, for Inpatients, and patients in “Observation”


Unfortunately for us who bill multiple payors for these services is the fact that Medicare has eliminated the consult codes, but  the other insurance companies have not not, at least not yet.   So you don’t use consult codes for Medicare and the Medicare alternative companies, but  you do use them for others?   Are your doctors going to make the decision of which code to use depending upon whether the patient has Medicare or not?  This gets even more complex when Medicare is primary and requires the new codes, but another payor is secondary and they do not use the new codes and you must bill differently for the same procedure(s) to each payor.


I am instructing my clients to continue to use the consultation documentation requirements for all consults, including requiring the referring physician name and NPI in case the patient has another primary insurance.


An excellent “flow chart” has been developed to help providers determine the appropriate E&M codes to use for what used to be a “consult”.   See  www.emuniversity.com/consultinfo.html

Health Care Stakeholder Meeting


Health Care Stakeholder Meeting – Physicians

White House Office of Health Reform Director Nancy-Ann DeParle will be leading another Health Care Stakeholder Discussion, this time with over 30 physician leaders from around the country, including deans of medical schools, CEOs of teaching hospitals, leaders of specialty societies, chairs of academic departments, and several private practice physicians.


• Watch it streamed at WhiteHouse.gov/live


UPDATE: This event has now concluded but Rebecca Adelman,  HHS correspondent, reports back:


Over 30 physician leaders from across the country, including deans of medical schools, CEOs of teaching hospitals, leaders in medical specialties, and practicing physicians gathered on the third floor of the Old Executive Office Building today to talk in very specific terms about ways to reduce health care costs, assure quality health care and improve the experience of practicing medicine in America. Director of the White House office of Health Reform Nancy-Ann DeParle opened the event along side four physicians working on health care reform in the Administration: Dr. Dora Hughes, Dr. Zeke Emanuel, Dr. Bob Kocher and Dr. Kavita Patel.


The discussion, moderated by DeParle and the four physicians, touched on a wide range of issues affecting the practice of medicine. Dr. Kocher began the discussion by outlining the President’s vision for health care reform: a health care system that guarantees choice of doctors and plans, invests in prevention and wellness, improves patient safety and quality of care, and assures affordable health coverage for all Americans. Dr. Emanuel then asked for specific ideas from the physicians “in the trenches” on how to improve quality and keep health care costs down. From there, the spirited conversation centered on concrete ways that hospitals and medical practices could be more efficient, notably by incorporating health information technology, and many spoke of the need for new financial incentives instead of fee for service.


There was wide agreement that health care reform must address the shortage of primary care physicians, as debt from medical school is discouraging new physicians from choosing primary care as a specialty. Dr. Hughes also asked the group to weigh in on the role of the government in health care reform, and many doctors responded that encouraging personal responsibility and increasing education are ways the government could help improve public health and prevent chronic diseases. Thanking the doctors at the conclusion of the 90 minute meeting, Nancy-Ann DeParle called the meeting both “invigorating” and “helpful.”