maine4me
Guru
I work with a hospitalist group, and we often bill services for patients in observation. We are having an issue when the patient is in for more than 2 days. Independence Blue Cross is denying the 99213 - 99215 for a referral when we use these codes for the subsequent visits. They do not accept the new codes 99224 - 99226. I know these codes are only to be billed by the admitting or supervising physician, often times we do not fit into this category, so need to bill using the 99213 -99215. I am being advised by the network coordinator that based on our contract we are obligated to bill these services the way they tell us to. They are also indicating that the 99213 - 99215 are strictly office visit codes. I have reviewed the CPT Book and the CMS guidelines, and all the information I am finding indicates that billing these codes is appropriate. I have also reviewed the billing and more than 90% of the time we are getting paid. I would welcome opinions and advice as to how to handle this issue.