# 99253 vs commercial vs medicare



## Sandra Fender (Apr 29, 2013)

I have a PT that has highmark as primary and medicare as secondary. we were the consulting doctor, I charged 99253 for the days we saw her, now highmark paid but medicare is dening stating that is not a reconizable code. Should I have used 99222-99235 instead of the 99253 even though its consulting
(pt is in Kindred transitional care hospital)


----------



## mitchellde (Apr 29, 2013)

if the patient has Mcare secondary then you make a decision to bill the primary the same as you would Mcare or you bill the primary as a consult and write off the Mcare balance when they deny the service.  Also if you are providing a consult for a patient in the inpatient setting at the request of another physician, the first visit is either the consult or initial inpatient level.  all visits after that are subsequent care.  you cannot charge a consult for each subsequent day.


----------



## roxannel (Apr 29, 2013)

please see page 6 of this MLM if medicare is secondary payer.  http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/MM6740.pdf


----------



## Sandra Fender (May 1, 2013)

*thank you*

Thank you for your help.  I printed page 6 and will look into it. I am guessing that I print up a different HICFA and sent a copy of the EOB from the primary?


----------

