Urgent!!!Need help.e&m coding

[NishaJ]

Hi..We have received a denial for inpatient hospital care. A patient has seen by 2 physician who belongs to same speciality but different facility. one is attending physician and our physician is a consulting physician. since Medicare has no longer use of consultation codes ,both the physician has billed the inpatient hospital care codes.but consulting physician claim has denied as duplicate and rep stated as another physician from different facility has billed initial hospital care and paid......
I want to know how to proceed this denial.

please anyone help me on this denial......
thanks in advance..

 

[thomas7331]

To answer this question, one would need to know why a provider would request a consultation from another provider of the same specialty?

There isn't much you can do as far as coding this differently to get it paid. But if the two providers have different subspecialties or some kind of specialized training that would make this visit by the second provider medically necessary, then you should appeal that denial with supporting documentation and try to make your case. I'd include a copy of the attending provider's order for the consultation to help support it.

 

[NishaJ]

Attending physician has enrolled in Internal medicine, and our physician is a cardiologist. But currently our physician has listed under internal medicine only , That is why claim has denied.

 

[thomas7331]

If your MD is a cardiologist but listed as an internist, I'd recommend you get in touch with whomever in your practice is responsible for provider enrollment and credentialing - they can probably get this fixed easily just by filing the appropriate paperwork to the payers. If the provider is practicing in cardiology, that should be submitted as the primary specialty and internal medicine as secondary. Otherwise you may continue having problems like this with denials.

 

[mitchellde]

Also the admitting provider's claim must be submitted with the AI modifier.

 

[NishaJ]

Thank you all ....