How do hospitalists handle claim submission to third-party payors given Medicare’s determination to stop utilizing consultation codes?

While there is suspicion that some of the major third-party payors will follow Medicare’s ruling, nothing has been published as of press time. Until confirmed, third-party payors still recognize consultation codes as outlined in contractual agreements with physician groups. Nevertheless, hospitalists may be obligated to report the same code to primary and secondary payors.

Medicare will not allow you to change the code on the claim when they are the secondary payor. Third-party payers may have similar prohibitions in their contractual agreements when they are the secondary payor. More specifically, CMS states, “In cases where other payors 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 payor, physicians must submit claims with the appropriate visit code ... more.

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