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We perform a stent placement and pt went to ED 9 hours later

T

TCopeland1991

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Gray, GA
Help!. Our claim for placing the pt's stent was bundled with his visit to the ED 9 hours later in the day. Pt has bilateral Kidney stones. Dr., placed a ureteral stent to dilate the ureter in order to take care of pt,s stones given size and degree of stone burden, that we scheduled and performed a week later. Problem is that pt after having the stent place, went to the ED stating that he was having trouble urinating. (our drs always tell the pt if they are unable to urinate please let us know if after hours please go to the ED with any high fevers greater than 101.5, heavy bleeding or an inability to urinate). The ED dept performed a CT of his abdomen/pelvis w/wo. This is the problem. His CT scan at ED is being bundled with our stent procedure. How do I appeal this? Do I just send the information from the ED and our ASC letting the ins know that these were separate procedure and different facilities? Thank you Teresa
 
Teresa, these are two different encounters performed by two different providers at two different facilities. Thus, two different claims under two different tax IDs should be reported to the insurance company(s).
You might contact provider's representative of the insurance; they are capable to give an advice on this matter, but they need to see the processed claim information. If so, what is the denial's CARC?

Although, have you tried to bill the claim for the ASU service regardless of ED encounter?

Kindest regards,
 
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