Wiki E/M Payer question

[skwestern@premierhealthcare.org]

How do you all bill an office consult if the patient has commercial insurance as their primary but has Medicare secondary?
Feel we need to abide by consult guidelines for the commercial but then cannot bill using that code for Medicare. Any references or thoughts? Thanks much.

 

[mitchellde]

In the MCM, it states to bill the commercial the same as you would bill Medicare.

 

[dclark7]

According to CMS as stated in the MLN Matters #SE1010 (Related Change Request #6740) you can handle Medicare secondary in one of two ways, 1) 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 2) 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. This ifound on the bottom of page 5 to the top of page 6 at the following link: http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/SE1010.pdf