Wiki I need advise please on how to code/bill a Initial visit for a Hospitalist and a Consultation from a Specialist the same day from the same group.

[OGGPPL]

So we have an issue where patient comes in through ER, admitted by Hospitalist & a Consult done by a Specialist the same day. Now both are billing Initial care code 99223 and one gets paid & the other denied as only 1 unit of 99223 allowed per day .

Example : Pt came in through ER with a Fracture. Hospitalist admits the pt and bills 99223 as initial care. He also orders a consult by a Orthopedic the same day & he is also from the same group as Hospitalist . He also bills 99223 initial care as he sees the pt the first day of admission for the first time. Now since both are from same group only one gets paid & the other is denied as only 1 unit of 99223 allowed in a day.

Can someone please advise how can I get both Hospitalist & the Specialist paid as the specialty is different even though they belong to the same group. Thank You.

 

[thomas7331]

If the patient has Medicare (or another payer that does not accept consultation codes), the hospitalist should bill 99223 with modifier AI to distinguish the service from the consultation. If the payer allows consultation codes, then the specialist should bill from the code series 99251-99255 instead.

 

[OGGPPL]

Thank you so very much Thomas.
I am going to try adding AI mod to the Hospitalist claim and if the payer still allows consultation then will pick one for the Specilaist. Thank you very much.

 

[Orthocoderpgu]

Thank you so very much Thomas.
I am going to try adding AI mod to the Hospitalist claim and if the payer still allows consultation then will pick one for the Specilaist. Thank you very much.

Before billing a consultation make sure that all three "R"s of a consultation are met. Otherwise, it's not a consultation.