Wiki Consult code when Medicare is secondary

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ChristieH

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When a consult code (i.e. 99244) is billed and paid by the primary commercial payer, how does your office file the secondary claim to Medicare? Medicare does not allow consult codes any longer. Do you change the code to a comparable Medicare code and file it, or do you just turn the balance over to pt responsibility? If you have an answer or know where I can get the answer, it would be greatly appreciated.

ChristieH, CPC-H
 
This is covered ion the MCM I just do not remember the section but you can search the MCM using the key word consultation. They state the choice is to bill the primary as a consult and write off the balance or bill the primary the same as you would bill Mcare.
 
Thanks for your input Debra. I will check this out for sure. I have been given two different answers both by Medicare customer service reps. Also, I have looked everywhere I know to look for a documented answer by Medicare and haven't found it yet. My boss says we will bill the patient for their balance, and I told her we cannot do that. I was told by one MC rep to change the code to a MC equivalent code and then submit claim. The boss we can't do that. Thank you for your help:) Christie
 
Debra, thank you. I found the info about the consult codes when MC is secondary right where you said it would be. I can finally put this one to rest and show my coworkers/manager that we cannot just bill the patient the balance once the pri ins pays. There are two choices to get it processed/paid by MC correctly and legally.

I've seen you answer many a question on the forums; thank you for taking the time to help others/me. ChristieH
 
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