Medicare will no longer recognize consultation codes starting January 1, 2010.

To avoid denials, it is imperative that your providers and coding/billing staff are aware of the changes and what your process will be to submit claims correctly.

What is the change to consultation codes?

The consultation codes (99241-99245 for office/outpatient and 99251-99255 for inpatient) are still in the CPT manual for 2010, but will not be recognized by Medicare starting January 1, 2010.

Does that mean we can’t perform consultations for Medicare patients anymore?

No. Your providers will still be providing the same service, but it will need to be reported differently to Medicare.

Is there a crosswalk we can use to convert the consultation codes to other codes?

It depends on the code category.

The documentation requirements for office/outpatient consultation codes 99241-99245 mirror those of the new patient visit codes 99201-99205 and can be directly cross-walked.

The documentation requirements for office/outpatient consultation codes 99241-99245 are different from those of the established patient visit codes 99211-99215 and cannot be directly cross walked level by level.

The documentation requirements for the three highest levels of inpatient consultation codes 99253-99255 miror those of the three initial hospital care codes 99221-99223 and the three initial nursing facility care codes 99304-99306 respectively, and those levels can be directly cross walked.

If a provider is performing a service that would normally be reported with one of the two lower levels of inpatient consultation (99251-99252), there is no crosswalk available.

Note: The crosswalks noted above will not work for cases wehre the level of service is chosen based on time of counseling/coordination of care.

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