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