Notes for E/M Audio/Visual Training Slides 71 through 84
The Centers for Medicare & Medicaid Services (CMS) made changes to the billing of consultation services for dates of service January 1, 2010, and after. For these services, Medicare will no longer accept the consultation procedure codes. The instructions on current billing are located in the Change Request (CR) 6740 
and the Medicare Learning Network (MLN) Matters Article MM6740 .
Here is a brief listing of the changes. WPS Medicare has questions and answers and recordings of two teleconferences held on January 12 and January 14, 2010, on the Education/Training page on our Website.
- These changes do not apply to Medicare Advantage plans or to non-Medicare payers.
- Consultation procedure codes dated January 1, 2010, and after will reject as unprocessable. Physicians (physicians or non-physician practitioners) must submit a corrected claim and cannot bill the patient for the non-covered service.
- Physicians will choose the procedure code based on the location and complexity of the visit.
- Telehealth G-Codes are still available.
- Medicare will no longer have the stringent documentation requirements as with consultation services. Providers are encouraged to follow appropriate guidelines for continuity of care.
- Any physician seeing a patient for the first time in an inpatient setting can now bill an initial inpatient visit.
- The principal physician of record will submit an "AI" - two-digit alpha modifier - on his/her initial inpatient service.
- For a patient admitted to observation, only the admitting physician may submit a charge for an initial observation service. Anyone else seeing the patient in the observation unit will submit an office or other outpatient procedure code.
- More than one physician may bill an Emergency Department (ED) procedure when more than one physician sees the patient in the ED - this is not new.
- In an office setting, the physician will choose either a new or a subsequent patient visit based on whether the physician provided any face-to-face services to that patient within the previous three years. A patient is new if there has been no face-to-face service provided in the previous three years by the same physician or a member of the same group with the same specialty. A patient is established when there has been face-to-face contact within the previous three years.
- When Medicare is the secondary payer, the physician may choose whether to submit a consultation code or an E/M to the primary payer. When submitting the claim to Medicare for secondary payment, the physician may not submit the consultation procedure code.
- Physicians may also look to the prolonged care procedure codes when appropriate when billing their services.
Page Last Updated: Monday, 25-Jan-2010 13:59:01 CST
