We had a claim for 99222 that was denied by Aetna since another provider had billed for it first. We are the attending physician (and was the one who asked for a consult with the other provider) so I appended the modifier -AI, sent in the corrected claim with reconsideration form but they still denied it. They are claiming that the code can only be billed once per day.
I checked again and CMS guidelines say that it can be paid to different physicians provided that they are responsible for different aspects of care/are in different specialties and are billing under different groups, which is the case for us, supported by our medical records.
We have had claims with Aetna Medicare with the same issue overturned before, but this is a commercial policy, and I'm a bit at a loss at what my next step should be. I would be grateful for any suggestions.
I checked again and CMS guidelines say that it can be paid to different physicians provided that they are responsible for different aspects of care/are in different specialties and are billing under different groups, which is the case for us, supported by our medical records.
We have had claims with Aetna Medicare with the same issue overturned before, but this is a commercial policy, and I'm a bit at a loss at what my next step should be. I would be grateful for any suggestions.