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NCCI edit medicaid/hosptial

  1. Default NCCI edit medicaid/hosptial
    Medical Coding Books
    Hello please help
    I work for a specialists group and we bill for hospital services we are billing a 99223(H&P) and a 99233(sub hosp) on the same day two different doctors that are specialists Medicaid has started using the NCCI edits as of 2011 so my question is can we bill both the H&P and sub hosp on the same day? can we add a modifer to the 99233? someone advise
    thank you

  2. #2
    Location
    Columbia, MO
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    12,526
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    if they are the same specialty then no you cannot bill both visits, if they are 2 different specialties then perhaps you can appeal with the documentation to show medical neccessity for the 2 encounters of different specialty concerns.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Per the NCCI edits 99223 does not fall under the edit for 99233, which menas 99223 is not a component nor is it Mutually Exclusive of 99233. You should be able to bill for both services on the day of admittance without any modifiers on either code. It does not matter if they are of the same speciality or not. Once the initial hospital care has been billed out(99223) tho, you may not use it again if a different Dr from your speciality see's the patient. 99223 should only be used by the admitting physician. For initial inpatient encounters by physicians other than the admitttiong physician, see initial inpatient consultation codes (99251-99255)

  4. #4
    Location
    Columbia, MO
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    Quote Originally Posted by Lisa K Williams View Post
    Per the NCCI edits 99223 does not fall under the edit for 99233, which menas 99223 is not a component nor is it Mutually Exclusive of 99233. You should be able to bill for both services on the day of admittance without any modifiers on either code. It does not matter if they are of the same speciality or not. Once the initial hospital care has been billed out(99223) tho, you may not use it again if a different Dr from your speciality see's the patient. 99223 should only be used by the admitting physician. For initial inpatient encounters by physicians other than the admitttiong physician, see initial inpatient consultation codes (99251-99255)
    It may not be an NCCI edit however there is the rule that you cannot bill more than one encounter per day for the physician, two physicians in the same practice of the same specialty are considered the same provider so you can only bill one encounter, you cannot bill an initial inpatient and a subsequent on the same day. If they are of a different specialty then it becomes a different issue. However the consult codes are not recognized by any payer following CMS policy.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Evansville Indiana
    Posts
    451
    Default hospital
    Debra is absolutely correct.

    LeeAnn

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