Life without Consultation Codes

One month after CMS eliminated outpatient and inpatient consultation codes, physicians find themselves seeking additional guidance. This is especially true for inpatient services.

CMS does not provide a coding crosswalk to assist physicians in selecting an appropriate substitute code for visits previously billed with consultation codes. Physicians need to re-educate themselves on the evaluation and management (E/M) coding guidelines to ensure proper code selection. Ophthalmologists and optometrists benefit from the ability to use the ophthalmic visit codes (920xx) or the E/M codes in place of consultation codes.

Previously, physicians had five levels of service to choose from when billing inpatient consultations. CMS expects physicians to select initial admission codes for these services, now that consultation codes are not used. Unfortunately, there are only three admission codes (99221, 99222, 99223). These codes require extensive documentation that previously only would have been required for 99253, 99254 and 99255. Some Medicare contractors are publishing alternative codes for inpatient services that would have met the criteria for 99251 and 99252. Some recommend subsequent hospital care codes for these low level services. There is no common consensus by payers on how these inpatient services should be coded.

Watch your contractor websites for additional guidance on coding for inpatient consultations. Corcoran Consulting Group has written a FAQ on this topic, providing our crosswalk for both outpatient and inpatient services. Please contact us if you would like to order a copy.