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Thread: Medicare Secondary Billing

  1. #1

    Question Medicare Secondary Billing

    AAPC: Back to School
    Hello Everyone,

    I just wanted to get some opinions on Medicare secondary billing after billing primary payer a consultation.

    I wouls like some feedback an how you are doing your Medicare secondary billing when a Consult has been billed to the primary payer. Are you recoding it to the equivalent new/est patient visits to submit to Medicare, if so are you getting reimbursed or are you coding it as new/est patient from the beginning?

    The practice I work for don't have very many Medicare secondary patients, so I am trying to see which is the best way. Any sugesstions would be helpful.
    Sonja Little, CPC

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    There is n=just no real good way to do this. You cannot change the code and be successful because there is no equivalent crosswalk code for the consultation codes so your claim will not match the EOB. And the one office I know that has tried repeatedly to do this has discovered that it just does not work. If you are successful with changing the code (which they had to send via paper claim) chances are highly likely that the reimbursement you received from the primary for the consulation exceeds the Medicare allowable for the code you have chose to replace it.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    Thanks Debra, I am with you on that. I keep trying to explain this to my office manager who just does not seem to get it, so I thought I would get some fellow members opinions.
    Sonja Little, CPC

  4. #4
    Join Date
    Apr 2007
    Woodbridge, VA


    So we avoid any issues to secondary billing to Medicare, our doctors will not use consult codes on those patients with Medicare (primary or secondary). For office visits, they just use the New Patient codes.


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