Wiki Consult code MCR is sec ins

[ChristieH]

Physician bills a consult 99254 to a commercial ins but Medicare doesn't pay consult codes. How do we get Medicare to process the sec claim? Do we change the 99254 to an equivalent MC code?

I had a MC rep tell me after they deny to call the clerical reopen line and tell them to change the code (99223) and ask them to reprocess with corrected CPT. It worked once and then failed once.

Your thoughts are greatly appreciated,

Christie

 

[CBaer]

Consult Code MCR sec ins

Check out MLN SE1010 - Questions and Answers on Reporting Physician Consultation Services origingal date 01/04/10 revised on 11/08/11 and 08/27/12.

Q. Will Medicare contractors accept the CPT consultation codes when Medicare is the secondary payer?
A. Medicare will also no longer recognize the CPT consultation codes for purposes of determining Medicare secondary payments (MSP). In MSP cases, providers must bill an appropriate E/M code for the E/M services previously reported and paid using the CPT consultation codes. If the primary payer for the service continues to recognize CPT consultation codes for payment, providers billing for these services may either:
• Bill the primary payer an E/M code that is appropriate for the service, 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; or
• Bill the primary payer using a CPT 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.

Cheryl