Need help !!!!!!!!!!!!!! Urgent

NishaJ

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Our cardiologist billed 93306-26 and 99232 for same day. Alabama Medicaid has denied as Professional services cannot billed with hospital visit codes, and denied the claim.
Please advice how to work this .................
 

CodingKing

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I see similar posts from time to time, seems various states medicaid like to bundle interpretation and report component of diagnostic tests into the E&M if done by the same provider.

*EDIT*

I was able to find the information from the provider manual for physician services. You may be missing a modifier.

http://medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals/7.6.1.1G_Jan2017/Jan17_28.pdf


28.2.5

Physician(s) may bill for inpatient professional interpretation(s), when thatinterpretation serves as the official and final report documented in thepatient’s medical record. Professional interpretation may be billed inaddition to a hospital visit if the rounding physician also is responsible forthe documentation of the final report for the procedure in the patient’smedical record. The procedure code must be billed with modifier 26(Professional Component) and modifier CG (Policy criteria applied)appended.

Then it goes on to say

Physician(s) may not bill for inpatient professional interpretation(s) inaddition to hospital visits if the provider reviews results in the medicalrecord or unofficially interprets medical, laboratory, or radiology tests.Review and interpretation of such tests and results are included in theevaluation and management of the inpatient. Medicaid will cover either onehospital visit or professional interpretation(s) up to the allowed benefit limitfor most services.
 
Last edited:

roslyn jones

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Roslyn L. Jones, CPC - 2017 President Durham, NC Local Chapter

I would review ALabama Medicaid to see if the interp is bundled with the E/M first. Next wI would check to see if the 99232 had a Modifier 25 if appropriate. Then I would check to see if procedure 93306-26 was billed by another provider and paid. If so another more appropriate modifier is needed.
 

NishaJ

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Hi...

I have a doubt, whether the modifier CG can be used only in Rural Health Clinic claims , OR It can be used in Non -RHC also ....
 
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