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Consultation Code Redistribution – Are You Choosing The Correct E&M?

What these graphics illustrate: With Medicare’s recent abolishment of Evaluation and Management (E&M) consultation codes (CPT codes 99241-99255), effective January 4, 2010, we must now correctly choose the appropriate E&M code that best fits our patient examination, history and medical decision making process versus the historical consultation CPT code. The graphics below show the redistribution tendencies for cardiology and multi-specialty practices when choosing the correct E&M code to replace the historical consultation code for Medicare patients.

What this means to you: As the typical reimbursement for E&M CPT codes is less than that of consultation codes, it is vitally important for both the physician and coding/billing staff to choose the correct replacement E&M code as to limit the potential losses of revenue to your practice. Consultative services historically required greater levels of review for examination, history and medical decision making, therefore, the redistribution choices of your practice should mimic these levels of review when choosing the proper E&M code.