For those of you chiropractors who have been following Medicare’s new consult policy that recently went into affect, you may feel like we are yet again victims of another Medicare scheme to pick our pockets of the few reimbursements we do receive.
Recently Medicare removed reimbursement for Consultation Codes (99241-99245) and the impact is being felt across many health disciplines, including chiropractic. If you are unfamiliar with using Consult Codes, you have likely been missing out on significant income opportunities by documenting your services accurately.
Chiropractors, for the most part, view the consult as the time when we meet with a New Patient, answer a few of their questions and discuss the benefits of chiropractic care prior to actually performing an examination on the patient. This does NOT in any way meet the CPT definition of a consult code (99241-99245) and should never be billed as such.
On the other hand, a true consult occurs when a patient arrives in your office at the request of another physician. In other words, the other doctor (an MD, for example, is common) tells the patient to seek your professional opinion or expertise as a chiropractor. In this type of situation, with proper documentation and conditions met, you can bill a consult code (99241-99245) in place of your normal E/M code and (here’s the reason for their popularity), these codes will pay significantly better than standard E/M codes.
So, if your office receives MD referrals regularly, you have been missing out on a great opportunity to increase your income that, unfortunately, may now be drying up. For example, a typical billing of 99203 may be $100, whereas the consult equivalent of 99243 may be $150. I know several clinics who have increased reimbursement by thousands of dollars per year over standard E/M fees because of consult codes.
As of January 1, 2010, Medicare has indicated that it will no longer reimburse consult codes. For DC’s, we may view this is as no big deal since Medicare does not reimburse us for exams anyway. Unfortunately, since most third party payers and commercial insurance companies (such as BCBS, Aetna, Cigna, etc) use Medicare as a basis for payment decisions, many other insurance companies have stopped paying for consults as well! And that can be a big deal for us!
Based on this, I would recommend two action steps for you to take:
- Contact your large payers to determine if they are still paying consult codes. If so, keep (or start) using them until further notice.
- Eliminate billing consult codes to payers who have indicated that they are denying the code.
- Document the consult for either #1 or #2 as it is still important for the legal record, to indicate that the patient was a consult and that you have performed this services upon request from another provider. You may not be paid but you are still obligated to report the service as rendered.
While many would agree that Medicare’s policies frequently appear to torture chiropractors, this one has far reaching impact that crosses the line towards other payers as well. But, as mentioned previously, all payers have not yet adopted this new policy so be sure to utilize these codes while you can.
In the meantime, if new developments about this occur or if similar, new opportunities comes our way, I will be sure to let you know! And for those of you who are wondering if you are missing out on any other items related to billing, coding or documentation that would help you improve your reimburesements, the answer is likely “YES!” Take some time to fill out a FREE Practice Analysis Questionnaire and I will be glad to discuss how I may be able to specifically assist your clinic in this area, while also protecting you from unecessary audits due to your billing, coding or documentation mistakes!