Wiki Initial inpatient visit codes

[kirstencpc]

Any one else having problems lately with payers not wanting to pay the initial hospital codes 99221-99223, for a new inpatient visit even by providers who are not the admitting doctor?

I have lately received denials from payers saying that only 1 physician, the admitting physician, may bill for the initial visit, everyone else, even when new, must use the follow up codes 99231-99233. They are claiming to follow CMS guidelines, however the last time I saw the CMS guidelines on this, they specifically stated that the initial visit codes could be used by all physicians at their initial visit, regardless of CPT guidelines.

has anyone seen any new CMS guidelines that state otherwise?

thanks,
Kirsten

 

[Rvoigt]

I have been experiencing the same problem. I have been following CMS and AAOS guidelines and all payers seem to be denying inpatient consult codes and I cant find a consistent explanation. The only thing that sometimes works to get paid is to add a modifier.