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Since Jan. 1, Medicare has eliminated use of the consultation codes in the office and inpatient hospital settings. The financial implications of this are mixed.

First, the bad news. Medicare paid more for the scrapped codes than they do for the codes you are now expected to use. Last year, for instance, you would typically have been paid $92 for CPT code 99242 Office consultation, whereas this year you will typically receive $70 if you use E&M code 99202 Office or other outpatient visit.

So what’s the good news? To compensate for the loss of the relatively well-paid consultation codes, CMS has beefed up the “work Relative Value Units” associated with payments for certain other codes, such as the codes for new and established office visits. For instance, the typical Medicare rate for E&M code 99202 rose from $64 to $70. (There also were smaller increases in the work RVUs for initial hospital and facility visits.) To get a rough idea of how this impacts you, create a spreadsheet, like in the two examples.

BELOW, EXAMPLE 1: COMPREHENSIVE OPHTHALMOLOGIST'S SPREADSHEET.
This doctor sees patients four days a week in one office location, with one surgical day a week. (Reporting period is January to March 2009.)
Total 2009 revenue: $128,489
Total 2010 revenue: $136,685
Difference: $8,196 additional revenue

ABOVE, EXAMPLE 2: RETINA SPREADSHEET.
This doctor sees patients two-and-a-half days a week in three office locations, with two surgical days a week. (Reporting period is September to November 2009.)
Total 2009 revenue: $83,017
Total 2010 revenue: $86,193
Difference: $3,176 additional revenue

You should keep in mind that CMS also increased the reimbursement rates for all surgical procedures that have a postop period.

To complicate matters, your non-Medicare payers won’t necessarily follow CMS—some may continue to accept consultation codes.

In conclusion, for most Eye M.D.s with “standard” practices, the AAOE’s initial estimates suggest that these changes will be close to revenue neutral.

Please note. In the two examples, the 2010 projections assume that Medicare cuts associated with the sustainable growth rate formula are not implemented. For news on this, visit www.aao.org/advocacy.