ZamoraA
Contributor
- Messages
- 10
- Location
- Wolcottville, IN
We have been billing 99221-99223 for Initial hospital consults/ visits -for our specialty- even when other providers within their own NPI / specialty bill out also an 99222. Which we can do per:
The Rule: CMS explicitly aligns with the "per-specialty" rule for inpatient care. In their transmittals, they state that initial hospital care codes are per-diem services that can be reported by different physicians, provided they are not "of the same specialty from the same group practice.
However- we have been getting denials- and read this on CMS:
"For example, if an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial and subsequent observation care codes. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate."
How are you billing your hospital initial visits when other specialties also see the patient?
The Rule: CMS explicitly aligns with the "per-specialty" rule for inpatient care. In their transmittals, they state that initial hospital care codes are per-diem services that can be reported by different physicians, provided they are not "of the same specialty from the same group practice.
However- we have been getting denials- and read this on CMS:
"For example, if an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial and subsequent observation care codes. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate."
How are you billing your hospital initial visits when other specialties also see the patient?