Marina Posted Mon 22nd of September, 2014 13:57:50 PM
Our Dr. saw a patient in the hospital and billed code 99233. We recieved a denial back from Medicare stating another physician saw the patient the same day in the hospital and also billed 99233. Is therer a modifier I should be using when billing this code?
SuperCoder Answered Mon 22nd of September, 2014 23:26:13 PM
Thanks for your question. CMS offers a scenario where two physicians are covering for one another and both see the patient on the same day. CMS states that only one of the visits would be payable since the subsequent hospital visit code specifies "per day". CMS also specifies that if the physicians are responsible for different problems related to the care of the patient, and the physicians are of different specialties use a different diagnosis on the claim and the visits would be covered. Also, when billing for concurrent care there are certain circumstances where CMS will cover services for providers of the same specialty. If none of these scenarios apply to your physician, check for duplicate billing and also call Medicare to see if they will advise you on what physician billed services on the same day as your physician. With additional information you may be able to rebill your claim appropriately. See the attached link to the Medicare claims processing manual. Hope this helps.