jennifer.r.wake
New
Hello,
Our billing team has been receiving denials from several payers on our Subsequent Hospital Encounter claims (99231-99233). The denials we receive state something along the lines of the code being incident to the primary procedure code or being bundled. Per the CPT book these codes are to be billed per day, so I'm not understanding why we would get these denials, or how they are coming to the conclusion that one 99232 is incident to another 99232 the day before. For example (this is an Aetna patient):
01/31/17 99223 Initial Visit - Paid
02/01/17 99232 Subsequent Visit - Paid
02/02/17 99232 Subsequent Visit - DENIED stating "incident to primary procedure"
02/04/17 99232 Subsequent Visit - Paid
02/05/17 99232 Subsequent Visit - DENIED stating "incident to primary procedure"
02/06/17 99232 Subsequent Visit - Paid
02/07/17 99232 Subsequent Visit - DENIED stating "incident to primary procedure"
02/08/17 99232 Subsequent Visit - DENIED stating "incident to primary procedure"
Has anyone else been having this issue? Like I said, we have seen this with a couple payers now, not just Aetna. Any input would be appreciated!
Our billing team has been receiving denials from several payers on our Subsequent Hospital Encounter claims (99231-99233). The denials we receive state something along the lines of the code being incident to the primary procedure code or being bundled. Per the CPT book these codes are to be billed per day, so I'm not understanding why we would get these denials, or how they are coming to the conclusion that one 99232 is incident to another 99232 the day before. For example (this is an Aetna patient):
01/31/17 99223 Initial Visit - Paid
02/01/17 99232 Subsequent Visit - Paid
02/02/17 99232 Subsequent Visit - DENIED stating "incident to primary procedure"
02/04/17 99232 Subsequent Visit - Paid
02/05/17 99232 Subsequent Visit - DENIED stating "incident to primary procedure"
02/06/17 99232 Subsequent Visit - Paid
02/07/17 99232 Subsequent Visit - DENIED stating "incident to primary procedure"
02/08/17 99232 Subsequent Visit - DENIED stating "incident to primary procedure"
Has anyone else been having this issue? Like I said, we have seen this with a couple payers now, not just Aetna. Any input would be appreciated!