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Marguerite Posted Tue 05th of September, 2017 17:45:30 PM
I have a Gastroenterologist who charged a 99223 on DOS 1-25-2017 at Hospital "A". He then charged again the 99223 on DOS 4-25-17 at Hospital "B" and the ICD-10 codes are different. Medicare denied the 4-25-17 DOS stating regardless of the different hospital or ICD-10, the physician can't charge a 99223 and must charge a follow up hospital i.e., 99233. Is Medicare correct?
SuperCoder Answered Wed 06th of September, 2017 02:29:28 AM

Greetings from!


Initial Hospital Care codes 99221, 99222 and 99223 are used to report the first hospital inpatient encounter of a new or established patient by the admitting physician. One initial hospital care is payable per patient per hospital stay.


In your case, there are two different hospital stays and different diagnoses. So physician can bill initial hospital care code (99223) for both stays. You should send all the necessary documents to insurance and bill it again with a letter of appeal. Also, append appropriate modifier if necessary.


Please feel free to write if you have any concern or questions.



Marguerite Posted Wed 06th of September, 2017 14:16:41 PM
Medicare is always wrong! Don't trust what they tell you on the phone! I knew they were wrong and so glad I asked. What modifier do I use????
SuperCoder Answered Thu 07th of September, 2017 03:20:00 AM



Depending upon your documentation, modifier “AI” (Principal Physician of Record) shall be used by the admitting or attending physician who oversees the patient’s care, as distinct from other physicians who may be furnishing specialty care. The principal physician of record shall append modifier “-AI” in addition to the initial visit code. All other physicians who perform an initial evaluation on this patient shall bill only the E/M code for the complexity level performed.



Marguerite Posted Wed 20th of September, 2017 19:23:47 PM
I can't use the Modifier AI because another doctor admitted the patient. So does that mean I need to down code it to a i.e., 99233?
SuperCoder Answered Thu 21st of September, 2017 01:53:47 AM


Please note that initial hospital care code 99223 can be billed by admitting physician only once per day. Your physician cannot bill this. You should bill subsequent hospital care code 99233.



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