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Oncology & Hematology Coding Alert

CMS Speaks:

Weigh Your 2-Payer Consult Coding Options

Published on Fri Feb 26, 2010

In MSP cases, non-consult code for both payers may be best. If you have payers who didn't play follow-the-leader with Medicare in cutting out consult codes, you have a dilemma on your hands. You have to decide what to do when your physician performs a consult, the primary insurer pays you for the service, and Medicare is the secondary payer. Map Out a Strategy From MLN Article CMS announced the "Medicare Secondary Payer (MSP) will not pay for consults," says Samantha Daily, billing specialist with a practice in Portland, Ore. 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 [...]
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