Wiki Consult denial

[Chelsea1]

Our specialty doctor saw a patient in consult on 7/2/16 whom was admitted on 7/1/16 (we were not the admitting dr). The patient ended up being D/C (not by our service) on 7/2/16.


The same patient came back to the hospital again on 7/3/16 with the same problem and was admitted again (not by our service). She was seen again by our service in consult on 7/3/16.

Her insurance (Medicaid) is rejecting the second admission consult (99222) stating that procedure code billed is not correct/valid for services billed or the date of service billed. The paperwork indicating consults for those DOS as well as all hospital records has been sent and we still have a denial. My question is, is there a "time frame" so to speak from the initial cons (7/2/16) to the second consult (repeat admission) (7/3/16) that would possible be the reason for the second rejection?

 

[thomas7331]

My understanding is that the initial visit code is by admission. Having said that, payers and state programs have different rules about the handling of a readmission to the same facility for the same problem within a certain time frame and in they may have determined that this readmission was a continuation of the previous stay - that might be what you're running into here, but you'd need to check with you payer. If so, you could either recode it as a subsequent visit or appeal with an explanation of why you feel it's correct as is.