kayleeevans907
Networker
I'm working on a denial for a patient that saw two of our intensivists in the ICU on the same day. Dr. A saw patient 1st for just under 74 minutes so we billed 99291; Dr. B saw patient second so we charged 99292. This is how we have always billed critical care and we've had no issues with reimbursement until now.
Blue Cross is denying the claim for Dr. B's charge of 99292 stating that it is an add-on code. We clarified with them that Dr. A's claim has 99291 and since they are the same specialty that per CMS guidelines they must process the claim as if they were from a single physician. We've spoken with representatives and a supervisor and the final ruling is still that the charge for 99292 isn't considered billable unless it is on the same claim as 99291.
We already have a good amount of CMS resources that we've cited in our communications with them and will use these in our appeals but I wanted to reach out and see if anyone else has ever had this issue and how they resolved it? I'd also love any additional resources if people have them.
Thank you
Blue Cross is denying the claim for Dr. B's charge of 99292 stating that it is an add-on code. We clarified with them that Dr. A's claim has 99291 and since they are the same specialty that per CMS guidelines they must process the claim as if they were from a single physician. We've spoken with representatives and a supervisor and the final ruling is still that the charge for 99292 isn't considered billable unless it is on the same claim as 99291.
We already have a good amount of CMS resources that we've cited in our communications with them and will use these in our appeals but I wanted to reach out and see if anyone else has ever had this issue and how they resolved it? I'd also love any additional resources if people have them.
Thank you
