Medical Billing Forum

Billing => Billing => Topic started by: PMBS on September 15, 2017, 07:50:10 AM

Title: initial hospital 99223
Post by: PMBS on September 15, 2017, 07:50:10 AM
I have been getting a lot of denials from BCBS on cpt 99223.  My doctor is the admitting physician and it seems like the consulting physician is also billing the same CPT code.  Is anyone else having the same problem and what have you been doing to get it paid.  I have appealed it with BCBS and they denied my appeal. 

Any help will be greatly appreciated.

Thank you

Miriam
Title: Re: initial hospital 99223
Post by: kristin on September 15, 2017, 12:41:58 PM
Are you using the AI modifer? It used to be just for Medicare, but many BCBS carriers require it also, as well as other commercial insurances.
Title: Re: initial hospital 99223
Post by: PMRNC on September 18, 2017, 06:45:46 AM
If your provider is the principal physician of record they can bill using the modifier AI.

 
Title: Re: initial hospital 99223
Post by: PMBS on September 19, 2017, 08:20:15 AM
Thank you.  Yes, I have started using the AI modifier.  I have even sent in a corrected claim and appealed it and BCBS still denies the claim.  My physician is the principle physician too. 

Title: Re: initial hospital 99223
Post by: Michele on September 19, 2017, 09:47:03 AM
Do you have a provider rep?  They are usually very helpful.
Title: Re: initial hospital 99223
Post by: PMRNC on September 19, 2017, 10:07:30 AM
Some plans will only consider the E/M ONCE per day .. period so they go by whomever gets their claim in fast. If you are billing E/M inpatient visits it's good to get them out THAT day.

There might not be anything you can do as remember that the E/M service description is "PER DAY"
Title: Re: initial hospital 99223
Post by: PMBS on September 29, 2017, 08:42:55 AM
Thank you.  Yes, that is what I told him also but he takes forever to give us his hospital charges.  There is only so much that I can do.