Results 1 to 3 of 3

M/Care consults when TMHP or Comm 2nd

  1. Question M/Care consults when TMHP or Comm 2nd
    Medical Coding Books
    I would like to hear how other organizations are handling the new rule on Medicare consults when:

    Commercial Payer and/or Medicaid is secondary - they still accept the consult codes and should they receive more than one initial admission on the same DOS they are going to deny it.

    When the 835 files I am not sure if there is a process to stop these to change the code or if that is even appropriate.

  2. #2
    Burling, MA
    Based on the two options Medicare presented when a secondary carrier accepts the consult code and Medicare does not... I opted for billing the accepted Medicare code. I found it more cost effective to bill the code Medicare accepts and let it go thru to the 2nd carrier.
    More and more insurance companies will not accept a handwritten change/correction on a claim so there is so much extra time and cost invested. In other instances, certain claims crossover from Medicare automatically and then you are dealing with that correction.
    What I am recommending to doctors is to be more specific about their time with a patient so that they can bill ethically. For example, smoking cessation counseling, 50% of E/M visit counseling, prolonged service, overlooked procedures. Often, they lump everything into a consult when there is so much more. Fortunately, access to EMR documentation helps ensure coding is accurate.
    I am finding out through trial and error, as well as reading every carrier newlsetter that crosses my desk, that payers are slowly beginning to follow Medicare's guidelines. So be careful.

  3. #3
    Sioux Falls South Dakota
    We are billing the accepted Medicare codes to the secondary also. So far we haven't had a problem - but give it time with inpatient (office doesn't worry me much, but IP with the multiple initial visits sure does)
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

Similar Threads

  1. Palliative care consults
    By jasterling in forum E/M
    Replies: 1
    Last Post: 06-24-2013, 01:21 PM
  2. Psychiatry in office consults and 2nd opinion
    By 00056831 in forum Behavioral Health
    Replies: 1
    Last Post: 12-21-2011, 04:48 PM
  3. 2nd request Fracture Care Help
    By Snflwr in forum Orthopaedics
    Replies: 3
    Last Post: 12-09-2010, 02:58 PM
  4. FX care - 2nd request please
    By orthopaedic01 in forum Orthopaedics
    Replies: 3
    Last Post: 06-09-2009, 01:30 PM
  5. IP Consults VS Transfer of care
    By khoffman in forum General Surgery
    Replies: 1
    Last Post: 07-14-2008, 09:59 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.