For several years, CMS has argued that physicians were not using consultation
codes properly. They were using such codes in situations where patients were
self-referred, where no documentation of consultation was evident from the
referring source’s chart or where the physician was expected to assume care of
part or all of the patient’s problems at the first encounter (the so-called
transfer of care). Despite opposition from the specialty societies, in the
final rule, CMS has decided to stop making payments for consultation services
starting January 1, 2010, stating that in most cases, there is no substantial
difference in work between consultations and visits. CMS directs that the
inpatient consultation codes (99251-99255) will now be reported with the
99221-99233 inpatient initial admission service codes. In the office setting,
the consultation codes (99241-99245) should be reported with codes from the
99201-99205 series if the patient is new or has not been seen within three
years for a face-to-face Evaluation and Management (E/M) encounter, and with
codes 99212-99215 if the patient has been seen within three years.
