To date, the ACR has been fighting the elimination of consultation codes at multiple levels without success. At the recent American Medical Association (AMA) meeting, Gary Bryant, MD, and Eileen Moynihan, MD—the ACR’s AMA delegate and alternate delegate, respectively—submitted a resolution at the House of Delegates for the AMA to support legislation to reverse the elimination of consultation codes. Many specialties supported the resolution, which became AMA policy at the end of the meeting. The ACR, along with the AMA and other specialties, will now continue to pursue legislation so that consultation will not be eliminated. It is hoped that language to restore consultation codes will be added to a bill to reform Medicare’s Sustainable Growth Rate as the bill moves forward and hopefully passes.
Challenges on Other Fronts
Individual insurance company rules continue to plague physicians. For example, Trailblazer—the Medicare carrier for Texas and a few other states— recently released a memorandum to assist physicians in understanding the level of complexity for these codes, stating that this is the “bottom line” for evaluation and management codes. Trailblazer advises physicians not to code using the highest two codes when “fewer than three distinct medical conditions/complaints were evaluated and managed during the encounter.” This is substantively different from the level of complexity specified by CMS nearly 20 years ago, and physicians have all gone to great lengths to understand and abide by what constitutes different levels of complexity needed to justify our billing. I like things simplified as much as the next person, but what is the thought process behind such a dramatic change in the understanding of the work necessary to justify a level of billing? A typical rheumatoid arthritis or lupus patient generally has enough complexity to justify higher coding without requiring that three distinct medical conditions be evaluated and managed. To me, it seems as though Trailblazer is arbitrarily raising the bar to make it more difficult for practitioners to fulfill the complexity required for higher billing codes. The ACR has sent a letter to Trailblazer urging it to follow CPT rules.
Physicians must also monitor changes to International Classification of Diseases (ICD) codes as well. On October 1, 2009, several rheumatologists were surprised to find out that gout codes had been modified from one code to four codes. If you reported the previous gout ICD-9 code, your bill will be denied. The books that provide the updates for over 13,000 codes were sent to the ACR in early October. I am sure that most physician offices received their books at the same time, not giving anyone adequate time to review the information and determine what changes would affect their practice. It is also confusing that ICD-9 changes go into effect on October 1 each year and CPT changes are effective January 1. This allows the physician practice to be disrupted on a more frequent basis. Superbills must be modified twice a year instead of just once for the year. Gout codes will see more changes next year. See Table 1 (below) for the ICD-9 gout code changes for 2010.
