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One-Year Follow-up After the Discontinuation of Consultation Codes; How Have Physicians Adjusted?
By: Paul J. Schilling, MD, FACRO
Community Cancer Center of North Florida
Gainesville, Florida
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The Centers for Medicare and Medicaid Services (CMS) discontinued consultation codes (99241-99245 and 99251-99255) as of January 2010. This discontinuation resulted in a substantial revenue reduction for most specialist physicians. To partly compensate for the reduction on revenue, CMS did, however, increase relative value units for evaluation and management of office visits (99201 to 99215). This increase ranged from 2.0% to 7.2% among these codes.
Overall, the loss of these consultation codes resulted in a 21% reduction in non-facility revenue. That is, formerly billed consultation code of 99245 was reimbursed at $226.50, compared to evaluation and management code 99205, which is reimbursed at $178.89).
The AMA and 17 specialty societies conducted a survey in which 55 physicians from 17 specialties participated. Physicians were asked how the elimination of reimbursement of consultation codes has affected their revenue and coordination of care efforts for patients:
- 30% said that their practices have reduced their services to patients covered by Medicare or are contemplating cost-cutting steps that would affect care.
- 20% of physicians said they have eliminated or reduced appointments for new Medicare patients.
- 39% of respondents said they would defer purchase of new equipment and/or new information technology secondary to the cuts.
- 30% of surveyed participants said they are eliminating staff.
- 6% state that they are eliminating typed consultation reports. A prior requirement of specialty consultations
- 19% of physicians said they plan to stop providing typed reports.
20% of patients over the age of 65 have 5 or more chronic and concurrent illnesses, including cancer, and managing their care requires multiple specialists and coordination of care. Eliminating Medicare consultation codes fails to adequately recognize the time and effort involved in care coordination across all oncologic disciplines.
To send a letter detailing your concerns, please write:
Office of the Administrator CMS
Hubert H. Humphrey Building
200 Independence Avenue SW
Washington, DC 20201
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