Wiki Medicare Consult Code

[knperry]

Medicare has denied a claim for a consult because another doctor has already billed and has been paid for his consult which was done on the same day. What code do I use to get my doctor paid for his consult? Code 99221 was used and was denied.

Thanks

 

[orthobiller2000]

try using modifier A1

 

[Pam Warren]

Hold that thought. The AI Modifier is used only to report the initial inpatient hospital code submitted by the actual admitting physician, and you shouldn't use it arbitrarily just to get the claim paid.

If your doc billed a consult on the same day as another physician, and your provider is of a different specialty than the other provider, then you certainly are entitled to reimbursement, but you may have to appeal the claim, particularly if the other provider was the admitting provider and they didn't append the AI. There's no modifier for you to use that is going to point that out to them, though. If both consultations were for the same condition, then it's likely the denial was due to a medical necessity issue.

 

[knperry]

Thank You