Wiki Same Day Hospital Visit

[FirstLadi]

We have a physician Dr. A (Internal Medicine) who admitted a patient to the hospital due to the high blood pressure and diabetic insulin issues. During the stay the physician noticed that the patient had a very bad diabetic foot ulcer that need to be treated. The admitting provider called over to the Outpatient Wound Clinic and requested the assessment of another physician Dr. B (Internal Medicine with 10 years of Wound Care experience) for the foot ulcer. Dr. B is now trying to bill for her treatment level to the patient on that day but, the payer is denying her claim.

How can physician Dr. B get the insurance to pay for her visit to the hospital to treat the patient for the diabetic foot ulcer and wound care treatment?

Thanks

 

[danskangel313]

Is this for Medicare? And, was this a consultation?

 

[FirstLadi]

I am not sure which payer denied the claims but the services provided would have been considered consults for the internal medicine wound care physician.

Thank you

 

[thomas7331]

Medicare and most other payers considers two providers of the same specialty to be the same provider, so it's not surprising you'd get a denial. If you have any documentation to show that the second provider had a subspecialty of additional skill that would support a separate E&M charge, you can send that as an appeal. I've had some success in doing that for providers of different subspecialties.