Govt. Questions Medicare Bills For Consultation

The federal Office of the Inspector General (OIG) has said that the government paid out more than a billion dollars in 2001 for physician consultation services that were inaccurately coded.

Though it does not appear that action has been taken to audit physicians who incorrectly submitted codes for consultation services, the OIG has recommended that the Centers for Medicare and Medicaid Services educate physicians through the agency's Medicare carriers about the proper coding for consultation services.

“Medicare allowed approximately $1.1 billion more in 2001 than it should have for services that were billed as consultations,” according to a report by the OIG. “Approximately 75 percent of services billed as consultations and allowed by Medicare in 2001 did not meet all applicable program requirements, resulting in $1.1 billion in improper payments.”

It does not appear that the OIG broke down the total $1.1 billion in improperly coded consultations into specialties, but Chester Schmidt, M.D., chair of APA's Committee on RBRVS, Codes, and Reimbursements, said psychiatry's portion of Medicare billings is typically 3 percent to 6 percent. That would put the total attributable to psychiatry at as much as $60 million.

Schmidt said that for a psychiatrist to bill for consultation services, a request from another physician for a consult must be included in the record, and the record must also contain the consultant's written report to the requesting physician.

Schmidt told Psychiatric News that the OIG has said two fundamental problems characterize the improperly coded consults: they were either billed at the wrong level of consultation (there are five levels depending on the complexity of services provided) or there was improper documentation.

Schmidt said determination of the level of coding can be a complicated task but can be rendered simpler with the use of template that provides fields for entry of the variables necessary for calculating the level of consultation provided. Such a template can be found in APA's CPT Handbook for Psychiatrists, Third Edition, co-authored by Schmidt.

TheCPThandbook can be ordered by phone at (800) 368-5777 or online at<www.appi.org>. The OIG report, “Consultations in Medicare: Coding and Reimbursement,” is posted online at<http://oig.hhs.gov/oei/reports/oei-09-02-00030.pdf>.▪