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co-b20 medicare denial

Marguerite Posted Tue 31st of July, 2018 15:09:06 PM
The questions that people have asked you only says "we are working on this issue and will get back to you". This is from 2017. What is the status?
SuperCoder Answered Wed 01st of August, 2018 02:50:07 AM

Inconvenience is regretted.

Kindly provide us link and question again.

We will try to resolve the concern on high priority.

Thank you!

Marguerite Posted Wed 01st of August, 2018 18:33:35 PM
For example, Our On-Call Infectious Disease doctor for the hospital billed Medicare for a 99223. Medicare denied it with remark code CO-B20 because a "Hospitalist" doctor from a different group also billed the same CPT with similar ICD-10 codes. The Hospitalist claim got to Medicare first and they paid him. Our claim got there second and was denied. Now I have to appeal each on of these with Medicare by stating: "You have incorrectly denied this claim stating that these services were already provided by another provider. The other provider for whom you have previously paid has a completely different specialty than our provider. Our provider for this claim/appeal was the “On-Call Infectious Disease” Doctor for Kindred Hospital when the patient was admitted to the hospital. While the CPT and/or ICD-10 codes may be similar, the services provided were from 2 separate Specialty Doctors. Please re-process and remit payment to Diablo Infectious Disease Consultative Medical Group for services rendered to this patient in good faith. Medical Records are not necessary to re-process this claim per your customer service representatives who advised me to appeal this claim. We would greatly appreciate a positive outcome to this appeal. Thank You." THIS IS VERY TIME CONSUMING AND I MUST APPEAL TO MEDICARE WITHIN 120 DAYS FROM THEIR DENIAL DATE. IS THERE ANOTHER WAY AROUND THIS? ALL I CAN THINK OF IS ADDING A 25 MODIFIER? PLEASE ADVISE. THANK YOU.
SuperCoder Answered Thu 02nd of August, 2018 03:42:08 AM

CPT 99223 is for Initial Hospital Care; this code is billed once per day by the admitting doctor. If it is billed by two different doctors of different speciality on the same day, then it will be paid only once to the admitting physician.

In your case, you cannot bill this CPT code (99223) because the other provider already billed the same code on the same DOS.

It is suggested to bill appropriate inpatient consultation code (99251-99255) for the second doctor as per your documentation.

Ensure that you are billing the services under provider NPI for whom you are seeking the reimbursement.

Marguerite Posted Fri 03rd of August, 2018 17:38:46 PM
No, that is not correct. Medicare will pay for 99223 for 2 different specialty doctors. I just have to appeal it stating the above verbiage. As a test, I have had Medicare reprocess the claim by adding a 25 modifier and I am waiting for the results.
SuperCoder Answered Mon 06th of August, 2018 09:38:42 AM

Since the doctors are from different specialties, one should bill for the admission and other should bill for his hospital care, as long as documentation supports the medical necessity of both visits. Also, your doctor is on-Call infectious disease doctor from Kindred Hospital, then he should bill for his services as inpatient consultation.

Also, as both the doctors are seeing patient on the same DOS and billing same ICD-10-CM codes, you are likely to get denied. It is requested to submit at least one different ICD-10-CM code to draw attention of the payer to a different service.

Marguerite Posted Tue 04th of September, 2018 13:23:09 PM
All of my claims that I added a 25 modifier to and resent to Medicare that were denied for reason code CO-B20 have all been paid!
SuperCoder Answered Wed 05th of September, 2018 04:23:35 AM

It is good to know that you have been paid for the service. But, as per coding guidelines same service with same diagnosis cannot be billed on same day for the same patient. Since you have been paid for the services, payer will recoup the payment from other provider. Happy to know that your issues have been resolved. Happy working.

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