Wiki Medicare consults

[aksockmonkey@gmail.com]

When a pt has BC/BS (for example) primary and Medicare secondary, can you bill BC/BS a consult code (CPT 99243) and then when billing to secondary change the CPT code to a new pt visit (CPT 99203)? Seems odd to me that you could/would bill the same DOS with different E/M codes...thoughts?

 

[dclark7]

CMS has an MLN Matters Memo (#MM6740) which states on page 6 (of 9) that you can either bill the consult code to the primary and then change the code to an appropriate E/M for the service and report the actual amount paid by the primary or bill a non consult E/M for the service to the primary. Here's a link to the article.
http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/mm6740.pdf

 

[aksockmonkey@gmail.com]

Thank you so much for the info!