Is a Consultation Still Coded as a Consultation?

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Note:  The following article synopsis was NOT provided by BC Advantage. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains how Medicare’s 2010 payment policy changes affected consultation billing for specialists and other physicians. It covers the broader shift from consultation coding to office and hospital evaluation and management reporting, notes the role of CMS final rules, and discusses how different payer types and Medicare as a secondary payer may be affected. The piece is aimed at physicians, coders, billers, and practice managers who need to understand the policy context and the operational impact on billing workflows.

Why This Topic Matters

The article matters because it addresses a major Medicare billing change that directly affects how consultation services are reported and reimbursed. It is relevant for practices updating charge structures, coordinating with payers, and planning for documentation and billing workflow changes tied to the 2010 rule updates.

Article Sections

  1. Medicare 2010 consultation billing changes

    Introduces the 2010 Medicare policy changes affecting how consultation-type services were handled for outpatient and physician billing. It frames the issue in the context of CMS final rules and Medicare reimbursement changes.

  2. Frequently asked questions on coding and billing

    Presents a set of common billing questions covering office and hospital reporting, payer differences, secondary Medicare billing, and the broader impact on physician payment. The section also touches on practice planning considerations and education resources.

What You Will Learn

  • How Medicare’s 2010 policy changes affected consultation billing
  • Which general categories of E&M reporting were discussed for office and hospital settings
  • Why payer-specific billing guidance matters when consultation services are involved
  • How Medicare secondary payer scenarios were addressed at a high level
  • What operational issues practices were encouraged to review in response to the rule changes

Who Should Read This

  • Physicians
  • Medical coders
  • Medical billers
  • Practice managers
  • Healthcare consultants

Codes Discussed

Code Ranges Discussed

Modifiers Discussed


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