decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 12 (December)
No more consults: CMS releases 2010 fee schedule
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Article Overview
This article summarizes Medicare payment and billing changes in the 2010 Physician Fee Schedule, with emphasis on the elimination of consult payment, related evaluation and management service reporting changes, and several anesthesia and pain management updates. It is relevant to physicians, coders, compliance staff, and billing managers who need to understand how CMS policy changes may affect claim submission, reimbursement, and specialty-specific reporting requirements.
Why This Topic Matters
The article explains a significant Medicare policy shift that affects common E/M billing patterns and may alter reimbursement workflows across multiple specialties. It also flags anesthesia and pain management payment/reporting changes that could influence practice operations and overall Medicare revenue.
Article Sections
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Elimination of consult payment and related E/M billing changes
This section covers Medicare changes affecting consult billing and the broader shift toward other E/M service categories. It also discusses related payment and reporting implications tied to hospital and office visit services.
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Complicating matters
This section addresses administrative and payer-related complications associated with the policy change. It focuses on the need for a new hospital-related modifier and the potential impact on secondary payer processing.
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Other changes affecting anesthesia & pain
This section summarizes additional 2010 fee schedule updates affecting anesthesia teaching arrangements, quality reporting, and specialty-specific RVU impacts. It also notes related concerns for pain management practices.
What You Will Learn
- How the 2010 Medicare Physician Fee Schedule affects consult-related billing
- What broad categories of E/M services are implicated by the policy change
- Which specialty areas have additional updates in the same fee schedule release
- How anesthesia teaching payment and quality reporting are being updated
- What kinds of reimbursement and payer-processing issues practices should anticipate
Who Should Read This
- Medical coders
- Billing staff
- Compliance managers
- Physicians
- Practice administrators
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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