Wiki 99244

Create Wiki
V

veeramani14

Networker
Messages
77
Location
cpc
Best answers
0
Hello all,

Please clarify this scenario.

Primary insurance- Coventry
Secondary insurance-Medicare.

Coventry paid 144$ for 99244 balance $20 forwarded to medicare.

Can I still change and bill cpt 99244 to 99204 for MCR after coventry paid.

Thank you,
Veera
 
No you cannot change the code for the secondary since the codes need to match the ones on the EOB from the primary. You can write it off after Medicare denies or you can bill the primary the same as you bill Medicare.
 
I have appealed to Medicare that the primary insurance requires the 99244 with the eob's and they have processed the secondary payment. I have also done this when primary insurance requires 2 units on a procedure and Medicare will pay. Just try appealing it.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
 
mitchellde said:
No you cannot change the code for the secondary since the codes need to match the ones on the EOB from the primary. You can write it off after Medicare denies or you can bill the primary the same as you bill Medicare.
Click to expand...

According to CMS yes you can change the codes. Per MedLearn Matters Article MM6470, page 6, you can either submit a code that is appropriate for the service then report the actual amount paid and Medicare will determine of payment is due OR you can bill the primary payer with a consult code that is appropriate for the service and report the actual amount paid by the primary along with an E/M code that is appropriate for the service. https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/mm6740.pdf

We' been submitting claims the second way since 2010 and have not had any problems getting paid by Medicare.
 
You must log in or register to reply here.
Top