Sen. Arlen Specter (D-PA) has proposed an amendment to the current healthcare reform bill to preserve consultation codes for medical specialists.

Senate Amendment 3163 would require the Centers for Medicare and Medicaid Services (CMS) to delay for one year implementation of its decision to eliminate consultation codes for specialists. In addition, CMS will be required to consult with the Current Procedural Terminology (CPT) Editorial Panel of the American Medical Association (AMA) during the interim one-year period to modify existing codes or establish replacement codes to provide a coding structure adequately accounting for consultation services. 

A number of medical specialty societies have spoken up in opposition to the CMS ruling since it was originally announced in. To see what effect the ruling would have, the American Association of Clinical Endocrinologists (AACE) surveyed its membership and their polling indicated that if the consultation codes were eliminated, four out of five endocrinologists would be forced to drastically reduce or eliminate the number of Medicare patients seen in their practices.

The CMS rule, which goes into effect on January 1, 2010, would no longer allow physicians in all medical specialties to bill for consultations provided for patients referred to them by primary care physicians and it instructs providers to use other established patient evaluation and management (E&M) codes in their place.

The new provision to reimbursement policy is viewed by many component medical specialty organizations as a flawed proposal. In a December 11 letter to Senate majority leader Harry Reid (D-Nev.) and Senate Committee on Finance Chairman Max Baucus (D- Mont.) twenty-one physician specialty organizations requested that Specter’s amendment be included “in any relevant legislative vehicle expected to pass before the end of the year” and further stated that “the CMS decision will be detrimental to Medicare patients and providers because it will be implemented with little guidance to physicians, is inconsistent with efforts to promote coordinated care, and minimizes the effort involved in a consultation.  A one-year delay is imperative to ensure that Medicare beneficiaries are not harmed by this proposal.“

The letter further notes that “consultations, which typically occur when one physician requests an expert opinion or advice from another physician about a particular patient’s medical condition or treatment, are an established and critical part of medical practice. Consultations are utilized by virtually all physicians to coordinate care, often for the most medically complex patients and, until now, have been recognized by virtually all payers as distinct medical services. Not only is CMS’ decision inconsistent with Congress’ recent efforts to promote coordinated care but, even worse, it may reduce access to necessary specialty care for Medicare beneficiaries. This is because by removing the distinction between consultative services and other E&M services CMS’ decision will disincentivize the provision of cognitive specialty care upon which Medicare beneficiaries often rely for the treatment of complex conditions.”

 

The letter further goes on to note that the CMS decision does not adequately account for the level of time and effort involved in a consultation.  “The physician… uses his or her expertise to analyze and synthesize the medical data into meaningful recommendations that are individualized to patients’ needs.  Without proper reimbursement for these necessary valuations, physicians will be unable to perform them and patients will lose access.”   

 

The letter also points out that CMS has given very little instruction in coding and “little time remains to educate physicians before the decision is implemented on January 1, 2010.  The elimination of consultation codes is a significant change that requires substantial provider education and CMS’ expedited time frame will cause disruption for patients and physicians alike.”   

 

Senators are requested to “include Senator Specter’s amendment to delay implementation of consultation codes for one year in the health care reform bill or any relevant legislative vehicle expected to pass before the end of the year” and that the American Medical Association’s Current Procedural Terminology (CPT) Editorial Panel would be consulted to “modify existing consultation codes or establish new codes to accurately reflect the work of consultation services and to minimize coding errors.  Such a delay will ensure that patients and providers are not negatively impacted by expedited implementation of CMS’ decision.”  

 

 

The letter was signed by the following organizations: American Academy of Allergy, Asthma and Immunology (AAAAI), American Academy of Neurology (AAN), American Medical Group Association (AMGA), American Association of Clinical Endocrinologists (AACE), American College of Allergy, Asthma & Immunology (ACAAI), American College of Cardiology (ACC), American College of Gastroenterology (ACG), American College of Rheumatology (ACR), American Gastroenterological Association (AGA), American Medical Association (AMA), American Psychiatric Association (APA), American Society of Clinical Oncology (ASCO), American Society of Gastrointestinal Endoscopy (ASGE), American Urological Association (AUA), Coalition of State Rheumatology Organizations (CSRO), Heart Rhythm Society (HRS), Infectious Diseases Society of America (IDSA), Joint Council of Allergy, Asthma and Immunology (JCAAI), North American Neuro-Ophthalmology Society (NANOS), Society for Cardiovascular Angiography and Interventions (SCAI), and The Endocrine Society (TES). 

Secretary of Health and Human Services Kathleen Sebelius was also sent a copy of the letter.

 

The American Association of Clinical Endocrinologists has posted an online petition to reverse the elimination of these codes at www.keepthecodes.com.

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