Results 1 to 3 of 3

Denial due to Part A

  1. #1
    Boone, NC
    Default Denial due to Part A
    Medical Coding Books
    We saw a patient in our office on same date they were discharged from an inpatient stay at hospital (OV, xrays, FX care). We never saw the patient at the hospital. Mcr denied stating claim not covered by this payer/contractor. I sent appeal w/ copy of discharge showing patient was seen in our office later that date, after dischage. Appeal denied stating services done in an office setting, with a DOS that falls within our admission/discharge date on a hospital IP bill, should be billed to Part A.

    I'm really stumped on this one. Do I need to send our charges to Part A? Any opinions would be appreciated.


  2. #2
    Greeley, Colorado
    Was it one of your providers who discharged the patient? Is the visit unrelated to the hospital stay? Is the patient a resident of a nursing home? All of these will impact what you can bill for the OV and procedures to Part B. If your providers discharged and these services are not related to the discharge, I would use modifier -24. If the patient is a nursing home resident you can only bill the professional component for radiology to Part B, the technical component would be billed to the nursing home.

    Anyone else?
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Boone, NC
    Thanks for your response. My physicians didn't see patient at hospital. He was discharged by hospitalist and referred for ortho follow-up. Somehow he was seen here right after the d/c. He wasn't in a SNF on that date.

Similar Threads

  1. Ultrasound Denial due to not meeting relationship criteria
    By jnieto625 in forum Billing/Reimbursement
    Replies: 0
    Last Post: 09-12-2015, 12:49 PM
  2. denial due to inappropriate modifier
    By june616 in forum Modifiers
    Replies: 2
    Last Post: 07-18-2012, 02:20 PM
  3. Wellcare denial due to Modifier
    By LRoethlisb in forum Outpatient Facilities
    Replies: 2
    Last Post: 09-27-2011, 02:27 PM
  4. denial due to modifier
    By john maceachern in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 01-06-2010, 03:59 PM
  5. denial due to bundling
    By john maceachern in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 01-06-2010, 02:06 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.