Wiki 99231-99233 Inpatient Hospital Visits

[minoweka]

One of the section notes on 99221-99233 states:

EXCLUDES: Inpatient E&M services provided by other than the admitting physician (99231-99233)

That is exactly what is occuring.

We are receiving payment from MediCal and then they come back and recoup stating "submission/billing error" when billing 99232.

The physician's providing the services that are getting paid and then recouped belong to the same physician group (same tax id #) as the admitting physician.

Must the physician be the actual admitting physician or should I appeal because same tax ID#?


Thank you
Dorothy

 

[rda23@aol.com]

It sounds as if you are billing this correctly; the CPT guidelines indicate that post-admission work by physcians other than the admitting physician should be treated as Subsequent Care (99231-33) or Consulations (99251-55). I'd pursue the Tax ID angle -- and it might be worth asking if that's creating other transfer-of-care complexities.

 

[OCD_coder]

If the physicians are of the same group and are NOT subspecialists you can only bill one E&M per DOS.

 

[minoweka]

Thank you for these insights. I appreciate it.

 

[debrafl]

It sounds as if you are billing this correctly; the CPT guidelines indicate that post-admission work by physcians other than the admitting physician should be treated as Subsequent Care (99231-33) or Consulations (99251-55). I'd pursue the Tax ID angle -- and it might be worth asking if that's creating other transfer-of-care complexities.

What about providers that are palliative care ( part-B) and are called for consultation in a hospital setting. Can they bill initial visits and if, so how many times?

 

[csperoni]

What about providers that are palliative care ( part-B) and are called for consultation in a hospital setting. Can they bill initial visits and if, so how many times?

If you search the forum, this type of question comes up periodically. Here's my answer: it depends on the carrier policy.
Medicare specified guidance when they eliminated consult codes that ALL physicians seeing a patient for the first time each admission may use 99221-99223. Admitting bills with -AI modifier. All others without modifier (unless needed for other reasons like -GC or -FS).
Some carriers follow that same Medicare guidance and will allow multiple providers to bill an initial evaluation for each admission.
Some carriers have their own policy that ONLY the admitting physician should bill initial 99221-99223 and ALL OTHER providers (regardless of specialty) must bill subsequent 99231-99233.
You mentioned Part B, so I will assume Medicare which means each physician/group may bill one initial visit and all other visits as subsequent for each admission.