Much remains unsettled for former consultations in 2010

Why This Topic Matters

The article addresses a major coding transition that affects how common evaluation and management services were to be reported, while also highlighting unsettled administrative issues that could affect claims handling, audits, and payer edits.

Article Sections

1. Consultation services going away

   Summarizes the announced shift away from consultation reporting and the related Medicare payment change discussed by CMS. It frames the overall transition to other visit categories.

2. Replacement visit categories

   Covers the broader visit types CMS indicated would be used instead of consultation services in office and hospital settings. The discussion centers on the categories and setting-based distinctions involved in the transition.

3. Unresolved inpatient scenarios and contractor guidance

   Describes areas where CMS had not yet issued complete guidance, including concerns raised by medical directors and the need for future CMS communications. It focuses on operational uncertainty rather than final rules.

4. Multiple initial hospital care claims and admitting service issues

   Addresses how claims may be handled when more than one initial hospital care service is billed for the same patient. It discusses the role of a pending modifier and possible claim review edits.

5. Medical necessity and documentation of request

   Covers the documentation themes raised for supporting billed services when a physician opinion is requested. The section also touches on how auditors may view documentation in these situations.

6. Split or shared consultations

   Notes commentary on whether a shared visit restriction would continue to apply after the consultation changes. This section reflects uncertainty and discussion among the experts quoted in the article.