What’s New in Consultation Code Coverage – Ophthalmology Management

Medicare continues to change reimbursement rules, presenting challenges to ophthalmic practices. In 2010, coverage for consultation codes has been eliminated. Here’s a sample of some of the many need-to-know questions we are receiving.

This article answers the following questions:

  • What changes were made to the payment policy for consultations?
  • How will this change affect Medicare payments?
  • What CPT codes replace the consultation codes?
  • Is there a code “crosswalk” from outpatient consultation codes to E/M codes?
  • Is there a code “crosswalk” from the inpatient consultation codes to the E/M codes?
  • Is a written report back to the referring provider still required?
  • Will commercial payers and Medicare Advantage (MA) plans continue to recognize consultation codes?
  • Will commercial payers and MA plans continue to recognize consultation codes? What about Medicare secondary payer (MSP) claims?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:


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