AMA Concerned over CMS’ Elimination of Consultation Codes

CMS eliminated all consultation codes, except telemedicine consults, as of January 1, 2010, as part of its cost cutting measures.  As specialists bill for these codes more than primary care, it is those providers who have experienced greater revenue declines – most of whom by more than 5%, according to an article posted by Amednews.com, last week.

A survey of roughly 5,500 physicians found a number of financial repercussions and unintended consequences as a result of losing the ability to bill for those codes.  The Amednews article examines some of those losses.  The financial ones are to be expected, however CMS only predicted a revenue drop of around 3%.  Yet results of the survey demonstrated a higher loss.  Indeed, an infectious disease physician interviewed for the article said that his practice had experienced an 8% loss so far this year and even had to lay off two mid-level medical staff members and one biller in March due to the loss of the consultation codes.

More far reaching consequences that CMS would surely not want to happen would be less of “the kind of care coordination that CMS has been seeking in Medicare.”  Time spent reviewing charts and talking to families and other medical staff in the hospital setting are also not being recompensed, so that time may be decreased as well.  The article covers many other issues as well, including coding for new or established patients among primary care and other specialists.

The AMA has concerns over how this will affect patients, which primarily means less access for patients.  A neurologist explains what that means in terms of his practice: “One of the keys to neurology is to spend the time with patients.  Taking a good history is critical, so devaluing our time undermines the service.  Ultimately, it means some patients are not getting the care or attention that they should.”  On June 18, the AMA and 30 other physician organizations sent a letter to CMS expressing these concerns.