Wiki The Race to Submit a Bill - help please!

slmclaughlin

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Our family practice provider billed a 99236 [hospital observation] with the following diagnosis codes: 575.10, 574.20, 577.0.

We were denied by Noridian Medicare and told another physician had billed services at another hospital for the same DOS.

Research revealed the patient had indeed been transferred to a different hospital the same day, and the other provider billed Revenue code 206 [Intermediate ICU] with diagnosis codes: 577.0, 574.30, 574.40, 401.9, 715.90.

Is anybody aware of a modifier that would make the services our provider billed payable? When we called, we were told the other provider had gotten his bill in first, and therefore we would not be paid. I am hoping there is something we can do to change that.

thank you for your help!
 
I would use the -25 modifier to signify that your provider's services were separately identifiable.
 
What about -27? Multiple outpatient E/M encounters on the same date?

27 is for facility use only it cannot be appended to a physician service. I do not think the 25 applies either, I think you just need to appeal this denial with the documentation it looks like a systems error.
 
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