bsrinivasarao777

Networker
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chennai
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Hi
I hope all are doing well...
Please share your suggestion on this.

As per documentation, patient got admitted in ED with the complaining of abdominal pain then patient found to have gallstones by ED physician (99284). Finally patient got discharged and admitted as inpatient care settings on same day. In same date of service the admitting physician done H&P (99223) with the primary dx gallstones. Later on same day admitting physician performed cholecystectomy (47605-90 day global surgery)
In this scenario the CPT 99223 got denied as inclusive and I suggested append modifier “57”. After that claim denied as “globally bundled cannot be billable separately” & itz sounds like not inclusive.

Here do I need to proceed any appeal or can I adjust the charges as “bundled or inclusive” for the CPT 99223.

Please help me to fix it.
 
Last edited:

CICIB

Networker
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33
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99223-57,AI
47605

AI-HCPCS modifier AI must be submitted by the admitting physician for the initial hospital or nursing home visit.

Please let me know if this information helped
 
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