Revenue Cycle Insider

Question: A physician in my practice saw a patient who has Medicare, as well as a commercial payer for insurance. The physician provided a consultation. Who do I bill for the consultation in this situation?

Tennessee Subscriber

Answer: According to your respective Medicare Administrative Contractor (MAC) for Part B services, Palmetto GBA, Medicare would be the secondary payer in this situation. It’s crucial to check with the primary payer about whether they recognize consultation codes; some payers, including Medicare, do not.

If the primary payer recognizes the consultation codes, Palmetto GBA says you can take one of the following actions:

• “Submit an evaluation and management (E/M) code that is appropriate for the service to the primary payer and then report the amount actually paid by the primary payer, along with the same E/M code, to Medicare for determination of whether a payment is due.”
• “Submit a claim to the primary payer using a consultation code that is appropriate for the service and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service, to Medicare for determination of whether a payment is due.”

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC