Elimination of Medicare consultation codes impacts practices

December 1, 2010

As of January 2010, physicians lost one more category of income from the Medicare reimbursement table. Consultation codes were eliminated, with physicians being told to replace them with the lower codes for new or existing patients to cover consultation visits. On Call asked dermatologists around the country whether they had seen any impact on their practice when the codes were discontinued.

Key Points

According to a survey conducted by the American Medical Association (AMA) and reported in http://Amednews.com/, more than 70 percent of doctors had seen a decrease in their revenues of more than 10 percent. Nearly 50 percent of doctors reported reducing the number of, or time they spent with, Medicare patients, while most planned to postpone the purchase of equipment, cut staff or find ways of reducing workloads by not providing consultation reports or dealing with patients with complex conditions.

On Call asked dermatologists around the country whether they had seen any impact on their practice when the codes were discontinued, and how they coped with that impact. Most of the dermatologists who spoke to On Call say they know there has been an impact, but it is one that they are dealing with without making too many cuts in the way they provide healthcare.

"Eliminating the consulting fees definitely has made a difference. Everybody does consults, so doing away with that fee does decrease the revenue. So, yes, there is a hit. But is there a significant hit? I'm not working an extra day or cutting back staff because of it," Dr. Yrastorza says.

Little impact

In Oconomowoc, Wis., Richard Neils, M.D., reports that the code elimination has made little impression on his practice.

"We may not have used it as much, especially with Medicare patients, as we did with other insurers," he says.

Robert Koppel, M.D., practices in Metairie, La. He says, "It's just not a code that we used that often. I do see patients in the hospital, and doctors send me patients, but I haven't used a consult code for years, because it became so sticky to define the difference between a consult and a referral."