CMS' instructions on consult changes are finally out, and not a moment too soon. Program Transmittal 1875 to the Claims Processing Manual provides more details on how to bill for services after CMS stops paying for consult codes (99241 - 99245, outpatient and 99251 - 99255, inpatient).
One thing you should tell your doctors now: A physician who admits or oversees a patient's care during a hospital or nursing facility stay will add modifier AI (principal physician of record) to initial inpatient care codes (99221 - 99223, hospital and 99304 - 99306, nursing facility).
Update: Part B News has created a Modifier AI Decision Chart that you can download and distribute to staff.
According to CMS, all other doctors who perform an initial evaluation of the patient will simply bill with the appropriate E/M code.
Note: Your carrier or Medicare Administrative Contractor should not reject claims when modifier AI is appended to subsequent care or outpatient visit codes.
Part B News will provide more tips, tools and best practices for adjusting to the end of payment for Medicare consults in upcoming issues. And if you missed our Dec. 10, 2009, audio conference CMS Slams Door on Consults-Steps to Re-engineer your Coding & Billing, you can order a recording and the handouts now!