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Medicare secondary consult codes

  1. #11
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    Evansville Indiana
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    What about for a hospital consult? Say BCBS is primary and Medicare is secondary. I doubt that since BCBS is still recognizing consults that they will allow more than one Initial inpatient encounter, so you would have to bill as a consult wouldn't you? I guess you could bill as a subsequent visit but that would be a big loss of revenue.

  2. #12
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    Quote Originally Posted by rebeccawoodward View Post
    ...and this will be exactly why physicians may refuse new Medicare patients. I just saw on the news the other day where one of the Mayo clinics will no longer see Medicare patients....
    Wow, that's harsh. Our physician practices are going to not use consultation codes for any patients - here, the reimbursement difference between new patient visits or initial hospital visits and consultation codes is small. Administration determined that it wasn't worth the extra work.

  3. #13
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    Greeley, Colorado
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    If you don't use consult codes for non-Medicare primaries, how would they pay? If there is already an admit code submitted by the actual admitting MD they won't be paying another admit code...unless everyone is going to recognize the AI modifier, which I doubt because no one else is not recognizing consult codes. Everything I've read indicates AI is a Medicare only modifier...the no consult code issue is a Medicare only issue.

    When it was first proposed to drop consultations, I was all for it because it's so hard to get the docs to follow the rules...but this is truly a mess. Thank you CMS.
    Lisa Bledsoe, CPC, CPMA

  4. #14
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    Ellenville, New York
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    Quote Originally Posted by Lisa Curtis View Post
    If you don't use consult codes for non-Medicare primaries, how would they pay? If there is already an admit code submitted by the actual admitting MD they won't be paying another admit code...unless everyone is going to recognize the AI modifier, which I doubt because no one else is not recognizing consult codes. Everything I've read indicates AI is a Medicare only modifier...the no consult code issue is a Medicare only issue.

    When it was first proposed to drop consultations, I was all for it because it's so hard to get the docs to follow the rules...but this is truly a mess. Thank you CMS.
    We are "lucky" in that we don't have many MDs who visit the hospitals for consultations - the vast majorities of consults are done on office visits. There were a few, but again, using the volume of each type of service. Your question on what to do for inpt consultations was not addressed - we are going to see what happens with the first few claims with those to commercial carriers.

  5. #15
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    Ellenville, New York
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    Quote Originally Posted by Lisa Curtis View Post
    If you don't use consult codes for non-Medicare primaries, how would they pay? If there is already an admit code submitted by the actual admitting MD they won't be paying another admit code...unless everyone is going to recognize the AI modifier, which I doubt because no one else is not recognizing consult codes. Everything I've read indicates AI is a Medicare only modifier...the no consult code issue is a Medicare only issue.

    When it was first proposed to drop consultations, I was all for it because it's so hard to get the docs to follow the rules...but this is truly a mess. Thank you CMS.
    We are "lucky" in that we don't have many MDs who visit the hospitals for consultations - the vast majorities of consults are done on office visits. There were a few, but again, using the volume of each type of service, the decision was made to not use these codes. Your question on what to do for inpt consultations was not addressed - we are going to see what happens with the first few claims with those to commercial carriers.

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