I am having a terrible time getting subsequent visits paid for. The patient was seen on 09/17/12 for his first inpatient visit billed as 99221. Our physician seen him again on 9/18 and 09/19. It was my understanding we can bill for subsequent visits- 99231. Am I missing something? Lost!!!!!
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Wiki subsequent hospital visits
- Thread starter BABS37
- Start date
LouiseR1
Guru
There really isnt much info here to give alot of help....are you coding inpatient correctly or was patient labeled as observation status? if observation status then the appropriate codes need to be billed which may be why you are getting denials. Other than that yes you are able to bille subsequent visits based on medical necessity and documentation.
Hope this helps
Louise
Hope this helps
Louise
MikeEnos
Guest
Sounds like a credentialing issue, or wrong patient status
Exactly, if they were inpatients, it sounds like you should be able to bill for subsequent hospital care codes 99231-99233 unless another doctor of the same specialty/group sees the patient on the same day and also bills for it.
Is this happening for all providers and insurances, or is the problem isolated to one physician or one insurance? I wonder if it's a credentialing issue, or if your contract with that payer needs to be updated to include the subseuqent hospital care codes on the allowed schedule?
Of course, as Louise said, if the insurance has no record of the patient being admitted as an inpatient (say for example if they are under observation) and you are billing inpatient codes, they will of course deny those claims. Make sure you have the patient's status correct.
Exactly, if they were inpatients, it sounds like you should be able to bill for subsequent hospital care codes 99231-99233 unless another doctor of the same specialty/group sees the patient on the same day and also bills for it.
Is this happening for all providers and insurances, or is the problem isolated to one physician or one insurance? I wonder if it's a credentialing issue, or if your contract with that payer needs to be updated to include the subseuqent hospital care codes on the allowed schedule?
Of course, as Louise said, if the insurance has no record of the patient being admitted as an inpatient (say for example if they are under observation) and you are billing inpatient codes, they will of course deny those claims. Make sure you have the patient's status correct.
Hi! The patient was inpatient and his inpatient visit on 09/17/12 paid in full. The next two subsequent visits denied as 'included with pre/post op care' along with 'bundled' and they all seem to be denying that way. We have six physicians of the same practice who rotate care while at the hospital but only one physician is billed out per day. It's Medicare that is denying these... I'm thinking maybe a physician of the hospital billed out their visits. There really isn't a modifier that I can use to kick it out of the pre/post op care unless it's unrelated and they are clearly related visits... I don't know. Any other ideas?
RILEY1959
Guest
This happenes to us sometimes because we are a part if a large group of physicans with many differnet specialties but under the same tax id number. If the service is truly not realted to the patients recent surgery then you can appeal this explaining that you did not perfomr the surgy, etc. Some payors will do this over the phone and some require a written appeal. Either way it should pay.
cheermom68
Expert
Was a procedure performed on these patients?
A procedure wasn't performed by our group of physicians and none that I could see by the hospital either... Our physicians work under their own clinic and then see patients through the hospital as on call- depending on the need. And my other question is, if they deny for related service- how do I even fight something like that since they are clearly in as inpatient because of either a procedure performed or a continuation of the same related visit?