Wiki Inpatient only codes

BJROBERTS

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My physician performed an emergency inpatient only procedure, then transferred to patient to another facility. The patient was never taken out of an emergency status, how do I bill this and get paid? I know the hospital can use a modifier but I can't find anything for physician billing.

Any advise would be greatly appreciated.

Thanks!

Bobbi
 
As I understand it, the inpatient only restriction is a CMS facility payment policy - it applies only to hospitals and not to professional services that are paid under the physician fee schedule which has its own policies. I don't believe it will be an issue for your physician to be reimbursed on the basis of this.
 
As I understand it, the inpatient only restriction is a CMS facility payment policy - it applies only to hospitals and not to professional services that are paid under the physician fee schedule which has its own policies. I don't believe it will be an issue for your physician to be reimbursed on the basis of this.
 
Thank you Thomas but it does apply to the physician, I had a claim deny out because the patient was in observation. Denied out for POS 22. I now have two new cases that patients were operated on and transferred out, one I am already in the process of an appeal. I am just trying to find a way to avoid going through the appeal process.
 
There is no modifier or alternative way of billing to avoid this kind of denial. If the payer is following CMS rules, they should not be denying the physician claim for this reason, so it may be an error, or the payer may have a different policy. In either case, I don't think you have any other option than to appeal.
 
There is no modifier or alternative way of billing to avoid this kind of denial. If the payer is following CMS rules, they should not be denying the physician claim for this reason, so it may be an error, or the payer may have a different policy. In either case, I don't think you have any other option than to appeal.
My denials are coming from an Arizona Medicaid Plan, I will appeal using the CMS rule, hopefully they will follow and pay.

Thanks Again!
 
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