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The news is doing the rounds that consultation codes (99241-99255) will not exist in the year 2010. Pediatrics coders are pondering as to how it’s going to affect their practice.

CMS has proposed ending coverage of consultation codes (99241-99255) to boost payments for primary care services. The AMA intends to make use of these codes at least till CPT 2010. For Medicare and private payers that adopt Medicare’s consultation coverage change, you need to use E/M codes (99201-99215 for office visits or 99221-99223 for hospital care rather than using consultation codes (99241-99245 for outpatient consults and 99251-99255 for inpatient consults).

The proposed rule suggests redistributing the savings that would result from invalidating consultation codes into payments for E/M services like office visits (99201-99215, office or other outpatient visit…) and initial hospital care (99221-99223).

If enacted, the consult pay elimination could benefit general pediatricians who might witness a payment hike from increased frequently used office visit codes. However, pediatric specialists tend to bill more consultations could see a downslide in revenue.

What you need to keep an eye on: You’ll have to keep track of what insurers accept 99241-99245 (office consultation). Private payers that base their fees on Medicare might drop payment for consult codes rather than traditionally higher-paying consult codes.

Keeping pace with the CPT code additions and deletions is no cake walk. Apart from the CPT code book, you can also have access to CPT codes online by signing into one-stop medical coding websites. Some medical coding websites offer free trails, which you can try out before actually signing up for it.

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