Understanding E/M: Say goodbye to consult codes – What this means for your practice

Why This Topic Matters

The proposed change could alter how common physician encounters are reported and paid, making it important for practices to review documentation and billing processes ahead of implementation.

Article Sections

1. Overview of the proposed Medicare change

   Introduces the proposed policy shift and the general reason it is being considered. Explains the article’s focus on how the change could affect everyday billing and practice operations.

2. Concerns about consult coding and documentation

   Summarizes reported concerns from CMS, auditors, and coding professionals about consultation billing and documentation. Discusses the administrative complexity surrounding these services.

3. A world without consults

   Describes the broader operational implications of removing consultation billing from Medicare. Covers anticipated effects on documentation burden and the redistribution of work RVUs across other E/M categories.

4. Financial impact

   Examines how the proposed change could affect reimbursement patterns in different practice settings. Highlights the types of services and specialties most likely to notice changes in billing volume and payment.

5. Watch your documentation

   Focuses on the need to align documentation with the reported E/M service level when alternate codes are used. Notes differences between office and inpatient/facility settings.

6. Without consultation codes, here's what your fees might look like

   Presents a comparative fee schedule view showing consult services alongside the proposed alternate E/M categories. Includes a table of affected services and reference pricing context.