As you may have read in our post in December, we consulted with most of the major commercial payers, and consult codes are still being accepted by them in 2010. However, there is much confusion over secondary claim coding related to consult visits when Medicare no longer accepts consult codes but commercial payers do. We, along with Joy Newby of Newby Consulting, Inc., want to add some clarification to this issue.

When commercial is the secondary, either bill the secondary using the visit code (not a consult code) or contact the secondary to ask if you can revise to a consult–assuming the visit was a consult by
definition.

When Medicare is the secondary, the claim will be denied if billed as a consult, even though the primary commercial accepted the consult code.

We recommend that prior to passing through to Medicare as a secondary, you assign the proper visit level code to the secondary claim.

The reference for this statement is in a MedLearn article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf