Consultation Coding Update

As most of you are aware, Medicare no longer reimburses for services coded as consultations. It is not that Medicare no longer covers consultations, but that those that have occurred since January 1 must be identified with codes other than the evaluation and management (E/M) codes listed in the AMA's Current Procedural Terminology (CPT) as being for inpatient and outpatient consultations.

APA is working with the AMA and other specialty societies to have CMS either restore the consultation codes or at least provide an equitable way to use other CPT codes that will appropriately reflect the work done in a consultation.

APA's Office of Healthcare Systems and Financing has been monitoring how private insurers are responding to this new Medicare policy. Although some companies are still paying for claims using the consultation codes, several seem to have stopped recently, and it's reasonable to believe that more will follow Medicare's lead over time.

Questions? Call APA's Managed Care Help Line at (800) 343-4671.