Effective January 1, 2010, Medicare will no longer recognize consult codes. Instead, Physicians are being told to use the appropriate E/M code when billing for services that historically were classified as consults.  As Friday draws near, many questions arise such as how should your practice bill when Medicare is the secondary payer to a claim submitted to another insurer who DOES recognize consults?  In response to a question on this point, CMS had this to say,

 

“We do not have the authority to determine which services will be recognized  and paid by other third party payers. Some payers may choose to adopt this policy subsequent to this final rule. In cases where other payers do not adopt this policy, physicians and their billing personnel will need to take into consideration that Medicare will no longer recognize consultation codes submitted on bills, whether those bills are for primary or secondary payment.  In those cases where Medicare is the primary payer, physicians must submit claims with the appropriate visit code in order to receive payment from Medicare for these services. In these cases, physicians should consult with the secondary payers in order to determine how to bill those services in order to receive secondary payment. 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."