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Is It Time to Eliminate Consultation Codes?

Is It Time to Eliminate Consultation Codes? SPECIAL ARTICLE HEALTH CARE REFORM An Analysis of Impact and Rationale Joel I. Shalowitz, MD, MBA Background: As issues of health care cost escalation and 32.4%. When the requesting physician ordered a con- parity of payment between primary care and other phy- sultation, the error rate was 5.5%; however, with sicians have become more important, one proposal has lower paid referral requests, the error rate was 78.0%. been to eliminate consultation codes. Little is known about Changing ambulatory consultation codes to those for the current payment accuracy or financial impact of such new patient visits would save Medicare $534.5 million a change. per year. Methods: To assess the impact of consultation code Conclusions: Consultation codes are being billed erro- elimination, 2 assessments were conducted. First, from neously at a high rate. Furthermore, the differential cost June 1, 2008, to July 1, 2009, 500 consecutive referrals from primary care physicians to other specialists were to Medicare of these codes over those for new patient reviewed and matched with claims for accuracy of cod- evaluation and management codes is over half a billion ing and billing. Second, to evaluate the financial impact dollars per year. With the growing needs for cost http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

Is It Time to Eliminate Consultation Codes?

JAMA Internal Medicine , Volume 170 (1) – Jan 11, 2010

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Publisher
American Medical Association
Copyright
Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6106
eISSN
2168-6114
DOI
10.1001/archinternmed.2009.446
pmid
19901097
Publisher site
See Article on Publisher Site

Abstract

SPECIAL ARTICLE HEALTH CARE REFORM An Analysis of Impact and Rationale Joel I. Shalowitz, MD, MBA Background: As issues of health care cost escalation and 32.4%. When the requesting physician ordered a con- parity of payment between primary care and other phy- sultation, the error rate was 5.5%; however, with sicians have become more important, one proposal has lower paid referral requests, the error rate was 78.0%. been to eliminate consultation codes. Little is known about Changing ambulatory consultation codes to those for the current payment accuracy or financial impact of such new patient visits would save Medicare $534.5 million a change. per year. Methods: To assess the impact of consultation code Conclusions: Consultation codes are being billed erro- elimination, 2 assessments were conducted. First, from neously at a high rate. Furthermore, the differential cost June 1, 2008, to July 1, 2009, 500 consecutive referrals from primary care physicians to other specialists were to Medicare of these codes over those for new patient reviewed and matched with claims for accuracy of cod- evaluation and management codes is over half a billion ing and billing. Second, to evaluate the financial impact dollars per year. With the growing needs for cost

Journal

JAMA Internal MedicineAmerican Medical Association

Published: Jan 11, 2010

References