The traditional model for subspecialist consultations on hospitalized patients by outpatient-based rheumatologists may seem straightforward. Hospitalists (the inpatient specialists who now manage most in-hospital medical care in the majority of U.S. hospitals) typically call upon the rheumatologist’s expertise for joint swelling and a rash or fever of unknown origin, says Lianne Gensler, MD, of the…
UnitedHealthcare (UHC) recently proposed two policy changes that would have a negative impact on reimbursement for consultation services and evaluation and management (E/M) services when billed with modifier 25. The effective date for both of these proposed changes is Oct. 1, 2018. Consultation Services Under the proposed consultation codes policy, UHC would end reimbursement for…
NEW YORK (Reuters Health)—”Booster sessions” with a physiotherapist help older adults with osteoarthritis keep doing their exercises, a new systematic review and meta-analysis suggests. “There is strong evidence for the benefits of exercise for people with osteoarthritis or chronic low back pain. However, multiple studies have shown adherence to exercise declines over time, and the…
A brief has been filed with the U.S. Supreme Court that, if the court decides to hear the case, could have wide-ranging implications for online medical care and the limits of a physician’s First Amendment right to free speech. Medical Advice Via e-Mail Institute for Justice Senior Attorney Jeff Rowes filed the brief at the…
Two of the great traditions of medicine are the curbside and party consults. In the former, participating physicians informally discuss an especially difficult diagnostic problem. During the latter, a patient will approach the doctor to ask about some possible medical problem and what they should do about it. The advent of the Internet has brought…
With the elimination of consultation codes by the Centers for Medicare and Medicaid Services (CMS), many rheumatology practices are finding it a heavy burden to bill the appropriate codes for the time they spend with patients.
Comments on the Medicare decision to eliminate consultation codes
As of January 1, 2010, Medicare eliminated both inpatient and outpatient consultation codes.
April’s Coding Answer
One of the most troublesome coding decisions is determining whether a visit is a consultation or a referral. To avoid the hassle of incorrect coding, one must first understand the difference between a consultation and a referral.