inpatient visit

[jenniferp]

Has anyone else had this experience??

Our medical doctor sees a patient for medical issues/diagnosis at a psychiatric hospital.  We do a complete H&P because we have never seen this patient before and we bill a "NEW" initial inpatient visit (99222-99223).  The admitting psychiatric provider does a psychiatric history on the patient and also bills a new/initial inpatient visit (99222-99223).

We are paid on our 99222-23, but the admitting psychiatrist is not.  He is trying to say that we are billing an improper code because he is the "admitting" provider, even though there is nothing in the code description about it being ad "admit" code, just an initial visit code.  He says we're supposed to be billing a "consult" code, we tried to explain to him that insurance companies do not allow consult codes anymore (at least Medicare and Medicaid), then he mentioned 90972 which is a psychologic evaluation with medical services.  To us, that is more of a code the psychiatrist would bill.

The psychiatrist is telling us that it's only happening on "HMO" plans (we're assuming he means Medicare HMO/Advantage plans).  We have checked with our coding experts and they tell us we're not billing anything incorrectly if we saw the patient and did a full H&P on a new patient for the first time.  Is this just a matter of certain insurance companies not allowing multiple "INITIAL" visits on a certain date of service?

Any help or information on this would be GREATLY appreciated.

Thanks -
Jennifer

[Michele]

The 99222 is "initial hospital inpatient care services".  It doesn't matter whether they are new or established.  I believe the psychiatrist can appeal the denial with medical records and a short note explaining that the medical doctor did an initial medical exam, and that he/she did an initial psychiatric exam.

I'm not a certified coder, but we bill for a medical doctor who does the initial medical exams for a psych ward at a hospital.

[Sriram_Sub]

I am not a certified coder either. However, I read like we may bill a CPT 90791 which is for an integrated biopsychosocial assessment including H&P including mental status & recommendations. It also covers discussion with family and other sources to review and order diagnostic studies.
I guess we should try billing a 99222 and a 90791 (25 modifier) on the day of admission. Please do post an update. Thanks.

[Michele]

I don't believe they will cover the 90791 for inpatient hospital.