Spine Practices May Lose Money When They Do Not Bill for Consults

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Kim Pollock, RN, MBA, CPC, CMDP
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Teri Romano, RN, MBA, CPC, CMDP

Healio- October 2016
by Kim Pollock, RN, MBA, CPC, CMDP and Teri Romano, BSN, MBA, CPC, CMDP

Medicare eliminated payment for consultations in 2010, which resulted in significant revenue losses for spine surgeons and all specialists. All office consultations for Medicare patients became a new or established patient, or an emergency department visit if the patient was seen in the emergency department, which is an outpatient facility.

Due to this change, payment for these visits was reduced 20% or more. Inpatient consult revenue for Medicare patients was also lost. For inpatients, this meant spine surgeons must code an initial hospital care code or a subsequent hospital care code in lieu of an inpatient consultation code, depending on the circumstances.

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