crhunt78
Guru
Hello. I have a situation where one of our psych docs saw a patient at a Comprehensive Inpatient Rehabilitation facility (POS 61). The patient was elderly and had Medicare as primary insurance so our physician billed a 99223 instead of a consult code which is perfectly acceptable for Medicare purposes. Medicare, as the primary insurer, paid their part of the claim, however, when the claim was sent to the patient's secondary insurance, Magellan - Cigna's behavioral health plan, it was denied because they say that CPT code 99223 cannot be billed in POS 61.
Does anyone know what we should do with this secondary denial? Magellan wants us to use a CPT code from the range 99304 - 99310 (Initial/Subsequent Nursing Facility Care) but we don't think we should have to change the CPT code based on a secondary insurance denial because Medicare already paid.
Did we code this wrong in the first place? Should we have billed Medicare using 99304-99310 or were we correct in utilizing the consult crosswalk and billing the 99223? Has anyone else had this situation arise? Any help you can give me would be greatly appreciated!
Does anyone know what we should do with this secondary denial? Magellan wants us to use a CPT code from the range 99304 - 99310 (Initial/Subsequent Nursing Facility Care) but we don't think we should have to change the CPT code based on a secondary insurance denial because Medicare already paid.
Did we code this wrong in the first place? Should we have billed Medicare using 99304-99310 or were we correct in utilizing the consult crosswalk and billing the 99223? Has anyone else had this situation arise? Any help you can give me would be greatly appreciated!