In MSP cases, CMS suggests nonconsult code for both payers. Here's How to Handle MSP Situations Early on, when the transition from using consult codes was first being discussed, one of the issues still up in the air for coders was what to do if Medicare is the secondary payer, says Sandy Fuller CPC, MCS-P, HIS supervisor and compliance officer for Cardiovascular Associates of East Texas. Solution: Recently published MLN Matters article MM6740 indicates the following: "In MSP cases, physicians and others must bill an appropriate E/M code for the services previously paid using the consultation codes [99241-99255, Office or other outpatient consultation ...]. If the primary payer for the service continues to recognize consultation codes," you should bill in one of the following two ways: • Bill the primary payer an E/M code, and then report the amount actually paid by the primary payer, along with the same E/M code, to Medicare for determination of whether a payment is due. • Bill the primary payer using a consult code, and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service, to Medicare for determination of whether a payment is due. "The first option may be easier from a billing and claims processing perspective," indicates CMS in the MLN Matters article. Weigh Dollar Difference for Best Option "There is essentially no workaround for this situation,so you have to decide whether you will get paid better via payment from the primary insurer with a consult code versus the alternative (billing an E/M to both payers)," says Robert B. Burleigh, CHBME, president of Brandywine Healthcare Consulting located in West Chester, Pa. Potential snag: To read the MLN Matters article on the consult elimination, visit www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf.