Doctor or Accountant?

I went to medical school for the reason that most people go to medical school—to help people. And I chose rheumatology probably for the same reason that a lot of rheumatologists chose rheumatology— because I had a mentor who stimulated my interest in rheumatology. The experience of working with our courageous patients with chronic musculoskeletal disorders has been as fulfilling as I had hoped it would be when I started out 30 years ago.

So why is it that some days I feel more like an accountant than a rheumatologist?

Coding and documentation rules continue to be a bouncing ball of changes, and physicians have to continually follow minute rules that make you feel like you’re analyzing the internal revenue code. And while some changes may have offered some benefits to practice in the past, recent changes haven’t—and what’s coming down the pike in 2010 just might be the worst we’ve yet to experience.

Consult Coding in 2010

What’s new for 2010? If you have had problems distinguishing between new patients and consultations, have no fear. Consultation codes have been eliminated effective January 1, 2010. Physicians will only be able to report for new and established visits. The Centers for Medicare and Medicaid Services (CMS) decided to eliminate consultation codes because there appeared to be a correlation between the complexity of the codes and the level of errors made by submitting physicians. True, life would be much easier without thousands of current procedural terminology and diagnosis codes. Unfortunately, eliminating consultation codes reduces payment for specialists who must take extra time reviewing thick charts and diagnosing patients with complex medical situations. CMS is taking the money that would have been spent on consults and reallocating the money into new and established evaluation and management codes, increasing the reimbursement for these codes. This will provide a small increase of reimbursement for all physicians who perform evaluation and management procedures without recognizing the additional work performed by specialists.

And although CMS has eliminated consults, insurance companies have not determined what they are going to do. The Current Procedural Terminology (CPT) editorial panel has not deleted the codes from the CPT book, so the codes still exist. The question is, will non-Medicare carriers continue to recognize consultation codes? What happens when patients have secondary insurance? The coding and billing staff will have to be vigilant to determine if the consult code is valid at a particular insurance company. The administrative burden of coding continues.