Wiki BCBS denial for Subsequent observation care

[mooney2013]

Patient is BC Medicare, Cardiologist called in for a consult to observation I billed 99218 and was paid. His note states will follow up in AM of no significant arrhythmias okay to discharge from cardiac point of view. So he followed up on day 2 and patient ok for discharge, so I billed 99225 Subsequent observation care. The patients regular Doctor then discharged him. At first BC paid us but then they requested a refund for the 99225 stating can not have a 99225 and a 99217 on the same day. I appealed stating We are a different TIN, office and provider type. They upheld their decision. Is there any other way to get paid for the 99225?
Thanks
Kay

 

[heartyoga]

Subsequent observ care

I work for a cardiologist and usually when he gets called in for a consult, we bill 99203-99204 for first day, and 99213-99214 for second day. As an outpatient/23 hr observation visit, BCBS TN accepts these codes.

Hope this helps.