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Editor's Correspondence
May 10, 2010

A Case for Consultation Codes

Arch Intern Med. 2010;170(9):836-837. doi:10.1001/archinternmed.2010.120

I disagree with the premise of the article “Is It Time to Eliminate Consultation Codes?” by Shalowitz.1 For less than a 1% (actually 0.91%, using his figures) “savings,” elimination of consultation codes will eliminate access of many Medicare patients to these specialists. I have already closed my practice to new Medicare patients because I cannot afford to spend 60 minutes with a new patient at the already-low reimbursement rate. If consultations codes are eliminated, more specialists will do the same. I disagree with the author's statement that cognitive specialists “are paid so much more . . . for the same or less time spent with them [patients].”1(p16) Where are the data supporting this statement? Is it really plausible that the knowledge and experience in treating complex chronic illnesses will automatically flow from the medical specialist to the primary care physician with the 6% transfer of reimbursement? If you or a loved one should develop rheumatoid arthritis, do you think that a primary care physician will have the ability to counsel and educate the patient, to safely and effectively treat the illness, and to stay abreast of the rapid scientific advances in this field?

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