Wiki Up coding Consult (Mcaid pt) since the dialysis is not paid by Mcaid ???

[cynthiaarellano14@yahoo.com]

Our providers have Mcaid dialysis pt's that are consulted on in the hospital (IP) & I was wondering that if our Dr. does the consult visit & also see's the pt on dialysis (same day) can they up code the consult visit since Mcaid does not reimburse for the dialysis visit because this is extra time spent by our providers ???

 

[mitchellde]

No it is never appropriate or compliant to upccode an encounter when a service is not covered. You will bill both the consult and the dialysis and the payer will have to deny the non covered service.