decisionhealth Newsletters, Part B News - 2012 Issue 2 (February)
Consult codes: Still alive, causing confusion 2 years after Medicare ban
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Article Overview
This article explains the continuing role of consult codes in private payer and Medicare Advantage billing, with emphasis on payer variability, claim handling when Medicare is secondary, and the operational need for a clear internal process. It is aimed at coders, billing staff, and practice managers who need to understand when consult-style billing may still be relevant and where confusion commonly arises.
Why This Topic Matters
Even after Medicare changes, consult-code billing can still affect reimbursement, denial risk, and workflow decisions for practices that bill multiple payers. Understanding the article helps readers evaluate whether their organization needs payer-specific consult policies and review processes.
What You Will Learn
- How consult-code billing may differ across payer types
- Why Medicare secondary scenarios can complicate claim submission
- How practices can organize internal processes around payer-specific rules
- How transferred care scenarios can be distinguished at a high level from consult-oriented encounters
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Practice managers
- Coding auditors
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