Wiki Consult 2010 Non-Medicare

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Partha

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Does anyone have updates on Consult codes for 2010 as far as payers other than Medicare are concerned - Medicaid, United, Aetna, Cigna, BCBS, Oxford? Any info on how to handle Medicare as secondary.
 
I do know how to do Medicare secondary. YOu must make a decision when Medicare is seconday, Here is a blurb I got from Medlearn:
In those cases where Medicare is the secondary payer, physicians and billing personnel will first need to determine whether the primary payer continues to recognize the consultation codes. If the primary payer does continue to recognize those codes, the physician will need to decide whether to bill the primary payer using visit codes, which will preserve the possibility of receiving a secondary Medicare payment, or to bill the primary payer with the consultation codes, which will result in a denial of payment for invalid codes."
 
You'll have to call your payers individually. We did so, and learned that all of them will continue to accept the 2010 consult codes (this year at least).
Pam Brooks, PCS, CPC
 
In Colorado, we are required to file Medicare secondary electronic which means the claim does not pass through our hands to convert to non-consult codes. We may end up "eating" the secondary payment since non-Medicare(primary) consults reimburse pretty well. I have found no payer following Medicare in eliminating consult codes-I have received replies from Cigna, Aetna, Blue Cross and UHC.
 
we called Cigna today and was told to use the new consult codes - we also talked to UHC (that was interesting) and Healthnet and they are not using the new codes yet- was told that possibly w/in 90 days they might- We are trying to figure out what to do w/ medicare 2ndry right now
 
WPS who is the J5 MAC for states in the Midwest is currently hosting conference calls to educate. They state that on MSP claims with Consult codes it will be rejected as unprocessable, at that time you can convert the code and submit with the EOB from the primary.

For those of you in the WPS J5 MAC, these are the dates for the next 2 conference call if your interested.

Consultation Changes for 2010
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 6740 on December 14, 2009. This publication shows substantial changes in billing for consultation services provided in both facility and non-facility settings. This change does not affect telehealth services.

Per the CR, effective January 1, 2010 Medicare will no longer recognize consultation procedure codes. Instead, consulting physicians will submit an initial or subsequent visit procedure code.

Registration for this teleconference is not required. See below for the dial-in number and conference ID.

If multiple people from your office attend, please only use one phone line. Please dial-in to the teleconference at least 15 minutes prior to the published start time.


Date/Time Registration Information
01/12/10
9:00 - 11:00 a.m. CT Cost: Free
Teleconference Dial-In Number: (866) 685-4589
Conference ID: 47131014

01/14/10
1:00 - 3:00 p.m. CT Cost: Free
Teleconference Dial-In Number: (866) 685-4589
Conference ID: 47132909

We have also found out that UHC Medicare Advantage and Humana Medicare Advantage plans are following the Medicare Fee Schedule and will not accept Consult codes. This information is posted on their web sites.
 
Angela,
Could you tell me where you found the information on the advantage plans? I've looked at the carrier websites and must be looking over it. It would certainly help if you could be more specific.

Thanks so much!
S. Whitus, CPC, CPMA
 
swhitus said:
Angela,
Could you tell me where you found the information on the advantage plans? I've looked at the carrier websites and must be looking over it. It would certainly help if you could be more specific.

Thanks so much!
S. Whitus, CPC, CPMA
Click to expand...

Here is the link for the UHC, it is on the home page and you don't even need to log-in to access it. https://www.unitedhealthcareonline....ilesPdf/News/2010/ConsultationCode_Update.pdf

The last two paragraphs are the ones related to Medicare and Medicaid products.

The Humana link has apparently been moved. We did receive a table from the Kansas Medical Society, as they used their contacts with each of the insurance companies to compile a list for their members. It also states that Humana Medicare Advantage plans are following CMS.
 
All of the MADV plans we contacted state they are following Medicare guidelines, so we are not filing consult codes to them.

Also, per our MAC, we can convert from consult to the other codes when Medicare is secondary. Luckily, our computer billing program allowed us to create key codes that change the code when filing the secondary electronically, so we don't need to do it manually.
 
The problem I have with that is that there i no cross over between the old consult codes and the codes we are to now use in their place. They do not translate like that so what are the odds that you will be billing for visit levels that documentation does not support.
 
I was on the medicare teleconference they had concerning the new codes and they stated if you bill the primary the consultations code and then when billing medicare secondary-CHANGE the codes, as long as they have the billing amount and an EOB showing you billed a consult code, they will pay it if the patient has the coverage
 
herrera4 said:
I was on the medicare teleconference they had concerning the new codes and they stated if you bill the primary the consultations code and then when billing medicare secondary-CHANGE the codes, as long as they have the billing amount and an EOB showing you billed a consult code, they will pay it if the patient has the coverage
Click to expand...

My software will not allow the code to be changed before sending to the secondary. What should I do, just write off the balance?
 
mitchellde said:
The problem I have with that is that there i no cross over between the old consult codes and the codes we are to now use in their place. They do not translate like that so what are the odds that you will be billing for visit levels that documentation does not support.
Click to expand...

There are crosswalks in place, you can create your own by matching up the documentation guidelines and key components. For MSP, you will have to audit your documentation and consider place of service as well as status of patient (new, established). I'd be happy to email you our crosswalk, but the E&M guidelines from your local carrier should have published them by now.

If you decide to bill the consultation codes to your commercial payers, you will have to re-code the documentation for secondary submission to Medicare, because you may not write off the difference, nor submit a consult code to Medicare. They are aware the codes and EOB from primary won't match. If you code the E&M codes for both payers, you're going to lose revenue from your commercial payers. You have to base this decision on your Medicare volume. We did a cost analysis; specialists will take a hit, but the primary care docs and hospitalists will make out.

Pam Brooks, PCS, CPC
Physician Services Coding Supervisor
Wentworth-Douglass Hospital
Dover, NH 03820
 
mitchellde said:
My understanding is you will not be allowed to convert to non-consult codes once it has been submitted to the primary.
Click to expand...

I believe that is incorrect. Check MedLearn Matters article MM6740. It specifically instructs you to do so. As long as you bill appropriately to your primary payer (per your contract), and don't take any additional adjustments or writeoffs, you can re-code the visit to submit to MSP.

Pam Brooks, PCS, CPC
Physician Services Coding Supervisor
Wentworth-Douglass Hospital
789 Central Avenue
Dover, NH 03820
 
Walker22 said:
My software will not allow the code to be changed before sending to the secondary. What should I do, just write off the balance?
Click to expand...


According to the Medicare Fraud and abuse guidelines, you may not create any financial adjustments based on the patients Medicare beneficiary status. This means you may not adjust the co-insurance balance rather than re-code and re-submit because Medicare doesn't accept the code billed to the primary. No matter what you have to come up with to workaround in your system, you cannot write off the Medicare co-insurance.

Pam Brooks, PCS, CPC
Physician Services Coding Supervisor
Wentworth-Douglass Hospital
Dover, NH 03820
 
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