AAFP Urges Congress to Leave CMS Elimination of Consultation Codes Intact

October 26, 2010 05:05 pm News Staff

The AAFP has sent a letter to every House and Senate member expressing the Academy's strong support for the elimination of Medicare consultation codes in the final 2010 physician fee schedule.

CMS eliminated the consultation codes as part of the 2010 fee schedule, but some medical subspecialty organizations are actively urging Congress to overrule the CMS decision, according to the AAFP. In the Oct. 21 letter to Congress(2 page PDF), AAFP Board Chair Lori Heim, M.D., of Vass, N.C, urged congressional members "not to interfere with this finalized policy."

"As the Medicare agency accurately demonstrated in the proposed 2010 physician fee schedule and as the HHS Office of Inspector General has well documented, the distinction between consultations and other 'evaluation and management' services became drastically blurred over the past several years," Heim wrote. "Prior to CMS' elimination of these codes, Medicare reimbursement for consultation services was at a higher rate than that of corresponding office and inpatient visit services, despite similar work and documentation requirements."

According to Heim, confusion regarding billing for consultation codes versus evaluation and management codes has resulted in misuse of consultation codes. She warned that if "Congress should reinstate the abandoned consultation codes, this policy reversal would result in the further exploitation of these codes, cause rampant billing confusion by medical practices, and ultimately result in Medicare improper and excessive payments."

Heim pointed out that CMS was able to modestly increase the value of evaluation and management codes -- in a budget-neutral manner -- and update practice expense data values that were used to counteract the eliminated consultation codes.

Although family physicians also used the consultation codes, Heim noted that the Academy supports the elimination of these codes because it "continues to be financially impossible to justify any payment differences between consultation codes and 'evaluation and management' service codes now that their documentation requirements are similar."

"Since consultation codes have been removed from the Medicare program, physicians are all now enjoying less compliance risk due to this significantly simplified coding policy," said Heim.

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