Ophthalmology and Optometry Coding Alert

If you bill 99241-99255 to private payers, good luck getting Medicare secondary balance. Don't even think about billing a consult to Medicare -- even if the claim is to a Medicare secondary payer. Medicare may have scratched consultations off its list of payable services, but many other insurers did not follow suit. The dual system leaves you in a quandary when your physician performs a consult and the primary non-Medicare insurer pays you for the service, but Medicare is the secondary payer. The "Medicare Secondary Payer (MSP) will not pay for consults," says Samantha Daily, billing specialist with a practice in Portland, Ore. 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 [...]