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Consult 2010 Non-Medicare

  1. #1
    Default Consult 2010 Non-Medicare
    Medical Coding Books
    Does anyone have updates on Consult codes for 2010 as far as payers other than Medicare are concerned - Medicaid, United, Aetna, Cigna, BCBS, Oxford? Any info on how to handle Medicare as secondary.

  2. #2
    Columbia, MO
    I do know how to do Medicare secondary. YOu must make a decision when Medicare is seconday, Here is a blurb I got from Medlearn:
    In those cases where Medicare is the secondary payer, physicians and billing personnel will first need to determine whether the primary payer continues to recognize the consultation codes. If the primary payer does continue to recognize those codes, the physician will need to decide whether to bill the primary payer using visit codes, which will preserve the possibility of receiving a secondary Medicare payment, or to bill the primary payer with the consultation codes, which will result in a denial of payment for invalid codes."

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Dover Seacoast New Hampshire
    You'll have to call your payers individually. We did so, and learned that all of them will continue to accept the 2010 consult codes (this year at least).
    Pam Brooks, PCS, CPC

  4. #4
    Greeley, Colorado
    Colorado state Medicaid will recognize consultation codes for 2010. Just found that one out.
    Lisa Bledsoe, CPC, CPMA

  5. Default
    In Colorado, we are required to file Medicare secondary electronic which means the claim does not pass through our hands to convert to non-consult codes. We may end up "eating" the secondary payment since non-Medicare(primary) consults reimburse pretty well. I have found no payer following Medicare in eliminating consult codes-I have received replies from Cigna, Aetna, Blue Cross and UHC.

  6. #6
    Columbia, MO
    My understanding is you will not be allowed to convert to non-consult codes once it has been submitted to the primary.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Kachina Coders
    we called Cigna today and was told to use the new consult codes - we also talked to UHC (that was interesting) and Healthnet and they are not using the new codes yet- was told that possibly w/in 90 days they might- We are trying to figure out what to do w/ medicare 2ndry right now

  8. #8
    Kansas City, MO
    WPS who is the J5 MAC for states in the Midwest is currently hosting conference calls to educate. They state that on MSP claims with Consult codes it will be rejected as unprocessable, at that time you can convert the code and submit with the EOB from the primary.

    For those of you in the WPS J5 MAC, these are the dates for the next 2 conference call if your interested.

    Consultation Changes for 2010
    The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 6740 on December 14, 2009. This publication shows substantial changes in billing for consultation services provided in both facility and non-facility settings. This change does not affect telehealth services.

    Per the CR, effective January 1, 2010 Medicare will no longer recognize consultation procedure codes. Instead, consulting physicians will submit an initial or subsequent visit procedure code.

    Registration for this teleconference is not required. See below for the dial-in number and conference ID.

    If multiple people from your office attend, please only use one phone line. Please dial-in to the teleconference at least 15 minutes prior to the published start time.

    Date/Time Registration Information
    9:00 - 11:00 a.m. CT Cost: Free
    Teleconference Dial-In Number: (866) 685-4589
    Conference ID: 47131014

    1:00 - 3:00 p.m. CT Cost: Free
    Teleconference Dial-In Number: (866) 685-4589
    Conference ID: 47132909

    We have also found out that UHC Medicare Advantage and Humana Medicare Advantage plans are following the Medicare Fee Schedule and will not accept Consult codes. This information is posted on their web sites.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

  9. #9
    Phoenix, AZ
    Thank you very much for the information, Angela!! Passing the information along to our Patient Account Reps.

    Thanks again!
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  10. #10
    Could you tell me where you found the information on the advantage plans? I've looked at the carrier websites and must be looking over it. It would certainly help if you could be more specific.

    Thanks so much!
    S. Whitus, CPC, CPMA

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