Consultation codes for Medicare. Please help!

Lhorn

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Chicago, IL
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I wanted to know if anyone else is having a problem with Medicare and how they are billing consultations.

We are following the guidelines and appropriatley coding consultations in the hospital with the correct initial hospital care code, but are receiveing denials against the actual initial H&P that was rendered.

Example: Cardio bills a consult on date of service 7/3/10-99255 and we crosswalk to 99223INT MED already billed an H&P-99223 on date of serivce 7/2/10

Medicare denies the cardio doc as this service partially or fully furnished by another provider. We appeal and denial is still uphelp. After the second level appeal to QIC we get paid, but we shouldn't have to appeal!

We are also seeing these denials in office place of service. We are currently looking into how our claims are going out and being recieved.

Can anyone help?!
 

jthweatt

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Tuscaloosa, AL
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The admitting physician should bill 99221-23 with a AI modifier. Perhaps their office is billing incorrectly and this is holding your "consult" up. Is it just one referring office you are having problems with? You may want to verify that they are billing with the modifier.
 

Lhorn

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We are a multi-specialty practice (they are all our claims) and we are billing the initial H&P with the -AI modifier
 

tadavis

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I think your problem is the use of AI for the physician who is the initial admitting dr.--I would check with the ref dr to make sure both of you are not billing for the initial admit or if both of you are not using the AI mod
 

mitchellde

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Is the patient already being seen by this cardiologist? Was he seeing the patient in the hospital for issues they have already addressed in the past? if so then it is not a consult and should be billed with subsequent care codes.
 

Lhorn

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Thank you everyone, obviously no one is having the same problem we are. I believe it is a taxonomy issue with how our claims are being received at Medicare and provider number is populating.

We are billing correctly appending the -AI to the initial H&P and the doctor whatever specialty is appropriately billing a consult.

Thanks for your help, going to keep following up with our IT dept and Medicare.
 
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