Wiki Reject Code B9

[ABridgman]

I have never encountered this one before.

Medicare denied payment to my doctor who saw a patient as a followup in the hospital - code 99233

The reason B9 is "Patient Enrolled In A Hospice"
The Remark Code accompanying the rejection was N90

N90 - "Service covered only when performed by the Attending Physician"

In this case, my doctor was covering for the Attending Physician.

Is there any way to get this paid? I do not think it can be billed to the patient.

 

[cynthiabrown]

look at g modifiers in hcpc

 

[ABridgman]

Thank you.
I found it now.

GV, right?

I'm still fairly new at this...there's a lot of stuff to remember! But I don't remember anyone telling me about this one before!

I never would have imagined Medicare would try to bundle a "once-a-month" code along with a daily code, and then try to deny the daily code just because of the once-a-month code having been used!

Obviously, in the case of my patient...he had gotten 90960 that motnh, several different days of dialysis, yes...but NOT on the days he was actually in the hospital! That's coded differently...as 90935, if I'm right.

EDIT: Yes, just looked that up. 90935 if in hospital - but this cannot be coded on the same day as a followup - 99233 - can be coded only with 25 modifier on 99223 Admit day or 99239 - discharge day. this seems a little strange to me, ut there it is.

At any rate, seeing as there's a seperate code for dialysis while one is in the hospital, it seems strange to me medicare would have bundled the 90960 code with the hospital codes. Thanks for the tip off.