Medical Billing Forum
Medical Billing Forum - Get all of your billing & coding questions answered here!
Welcome,
Guest
. Please
login
or
register
.
Did you miss your
activation email
?
1 Hour
1 Day
1 Week
1 Month
Forever
Login with username, password and session length
News:
COUPON
- Get 15% off a purchase of $55 or more of your Medical Billing Resources! Coupon Code:15OFF
Click Here for the Products Page
Home
Help
Search
Login
Register
Medical Billing Forum
»
Coding
»
Coding
(Moderators:
Alice Scott
,
Michele
) »
Consultation Codes Denial
« previous
next »
Print
Pages: [
1
]
2
Author
Topic: Consultation Codes Denial (Read 2832 times)
skhakoo
Newbie
Posts: 2
Consultation Codes Denial
«
on:
June 19, 2021, 01:39:30 PM »
I work for a Neurologist office. We are experiencing high number of consult claims with CPT codes (99221 - 99223). Insurances such as Horizon BCBSNJ, Aetna and Amerigroup deny the claims and provide one of the following denial codes:
a). The number of Days or Units of Service exceeds our acceptable maximum.
Other denials provide the following denial codes:
a). Payment denied when performed/billed by this type of provider and this provider type/provider specialty may not bill this service.
I have been billing CPT code 99221-99223 for long time and I am stumped. This is the only Neurologist in this office (a solo-practitioner). We are billing 99221-99223 with # of units of 1. CPT 99221-99223 is used only once in the claim. It does not matter whether we are using 99221 or 99222 or 99223 - i have seen issues with all of these.
Is anyone else experiencing this issue?
How do i get around it?
THanks.
Shabbir
Logged
kristin
Hero Member
Posts: 703
Re: Consultation Codes Denial
«
Reply #1 on:
June 19, 2021, 03:45:53 PM »
The codes you listed are IP Initial visit codes. Is the neurologist the doctor that is admitting the patient to the hospital?
If not, those codes cannot be billed by the neurologist, they can only be billed by the admitting doctor. That is why you are seeing those denials, because the admitting doctor already billed the same code for the patient.
You have to bill IP Subsequent codes instead: 99231-99233
Logged
skhakoo
Newbie
Posts: 2
Re: Consultation Codes Denial
«
Reply #2 on:
June 20, 2021, 09:02:01 PM »
Thanks Kristin for your response. So two things:
a). The Neurologist is not the admitting physician.
b). The way I am reading your response is that if a specialist is not an admitting physician, then there is NO way for this specialist to be reimbursed for the initial consultation service. In other words, unless you are an admitting physician, initial hospital care service codes 99221-99223 are simply not allowed for any physician. Unfortunately, this is counter to my understanding. Per CMS guidance "CLM104c12", which Chapter 12 of Medicare Claims Processing Manual, section 30.6.10 talks about Consultation Services and no way in this section is this limitation that CPT codes 99221-99223 is only intended for Admitting physician. Section 30.6.9.1 bullet G specifically talks about "Initial Hospital Care Visits by Two Different MDs or DOs when they are involved in same Admission". The guidance here is straight forward and it states "In the inpatient hospital setting all physicians (and qualified nonphysician ...) who perform an initial evaluation may bill the initial hospital care codes (99221-99223)". It further talks about modifier AI to identify the Principal physician of Record.
It is therefore my understanding that if a patient is admitted by a PCP, and the PCP then subsequently calls in consultation to a Neurologist and Cardiologist, the correct billing would be:
PCP - 99221-99223 with modifier AI
Neurologist - 99221-99223 without any modifier
Cardiologist - 99221 - 99223 without any modifier
Is my understanding incorrect?
Thanks.
Logged
Michele
Administrator
Hero Member
Posts: 5927
Re: Consultation Codes Denial
«
Reply #3 on:
June 20, 2021, 09:44:23 PM »
My understanding is the same as Kristin's. I have only seen plans allow one admission code per inpatient stay. It may be that is how it is supposed to be coded, but it may not be allowed by the insurance plans.
Logged
Sign Up for our FREE
Medical Billing Newsletter
Get a 10% discount on
Medical Billing Products
by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com
Geaceborb
Newbie
Posts: 30
Re: Consultation Codes Denial
«
Reply #4 on:
October 12, 2022, 08:37:04 AM »
nirmatrelvir ritonavir will increase the level or effect of nelfinavir by affecting hepatic intestinal enzyme CYP3A4 metabolism <a href=https://bestcialis20mg.com/>cialis 20mg for sale</a> New York John Wiley and Sons
Logged
cialis cheapest online prices
Medical Billing Forum
Re: Consultation Codes Denial
«
Reply #4 on:
October 12, 2022, 08:37:04 AM »
updastE
Full Member
Posts: 139
Re: Consultation Codes Denial
«
Reply #5 on:
October 26, 2022, 05:45:18 AM »
<a href=https://stromectol.autos/>stromectol for humans for sale</a> The level of Bcl 2 decreased by the combined drug treatment at 48 h
Logged
stromectol dose for scabies
mainiaDup
Sr. Member
Posts: 260
Re: Consultation Codes Denial
«
Reply #6 on:
November 13, 2022, 11:42:01 AM »
Bob NdYeNbLTqqH 5 29 2022 <a href=http://priligy.me/>priligy review members</a>
Logged
priligy 60 mg
royagma
Sr. Member
Posts: 326
Re: Consultation Codes Denial
«
Reply #7 on:
November 16, 2022, 07:58:06 AM »
<a href=https://lasix.autos/>lasix</a> Male breast cancer usually presents as a painless lump
Logged
taking lasix but still swelling
unorgobug
Sr. Member
Posts: 330
Re: Consultation Codes Denial
«
Reply #8 on:
November 19, 2022, 04:21:41 PM »
Barbera jEewoNiAmockH 6 27 2022 <a href=http://doxycycline.world/>doxycycline photosensitivity</a> 10, 11 Participating centers were encouraged to perform quantitative biochemical ligand binding assays LBA
Logged
doxycycline nausea
awaixebra
Full Member
Posts: 239
Re: Consultation Codes Denial
«
Reply #9 on:
December 09, 2022, 10:05:45 AM »
<a href=https://propecia.hair>cheap viagra and proscar</a> c Fos is used to identify system wide neural activation with cellular resolution in vivo
Logged
best price for generic cialis
Medical Billing Forum
Re: Consultation Codes Denial
«
Reply #9 on:
December 09, 2022, 10:05:45 AM »
piegmen
Sr. Member
Posts: 326
Re: Consultation Codes Denial
«
Reply #10 on:
December 09, 2022, 12:43:23 PM »
ERО± caveolin 1 complex formation in response to E2, TAM and RAL treatment in T47D A18 PKCО± tumors <a href=https://sviagrass.monster>is it safe to take viagra with beta blockers</a>
Logged
buy priligy generic
lapound
Sr. Member
Posts: 340
Re: Consultation Codes Denial
«
Reply #11 on:
December 12, 2022, 01:22:08 PM »
LetR cells were transiently transfected with ER siRNA, and mRNA was analyzed by qPCR <a href=https://stromectol.mom>stromectol lice</a> Is ovarian suppression ablation past history or still a useful current therapy
Logged
propecia hairline
Vogegrorb
Sr. Member
Posts: 334
Re: Consultation Codes Denial
«
Reply #12 on:
December 16, 2022, 11:33:37 PM »
Also he told me that as I get older I would need glasses <a href=https://zithromax.one>buy azithromycin online no prescription</a> New York, 1994, 99 126
Logged
para que sirve levitra 20 mg
kparikh
Newbie
Posts: 2
Re: Consultation Codes Denial
«
Reply #13 on:
December 19, 2022, 04:02:40 PM »
Did you ever get the issue resolved?
As consultant we are also seeing increased denial for 99223. Denial reason number of units exceeds allowed per day.
But for initial consult we should be paid.
For Braven does anyone know whom to contact in NJ?
Logged
stacioutt
Full Member
Posts: 134
Re: Consultation Codes Denial
«
Reply #14 on:
January 28, 2023, 01:02:07 AM »
It took 20 months for us to conceive DD <a href=http://nolvadex.hair>nolvadex reduce puffy nipples</a>
Logged
lasix Deutschland
Medical Billing Forum
Re: Consultation Codes Denial
«
Reply #14 on:
January 28, 2023, 01:02:07 AM »
Print
Pages: [
1
]
2
« previous
next »
Medical Billing Forum
»
Coding
»
Coding
(Moderators:
Alice Scott
,
Michele
) »
Consultation Codes Denial