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denials

Alicia Posted Mon 30th of April, 2012 19:10:45 PM

We have been getting denials from medicaid and private companies. They are stating that they paid the hosptial where my Dr performs his out procedures. For example we billed a 43239 EGD and they state that they paid the hospital for the 43239. Is the hospital billing wrong. What codes should they bill? Thank You,

ALICIA

SuperCoder Answered Tue 01st of May, 2012 07:49:13 AM

If your physician is performing the procedures (EGD etc.) at hospital set up, he can bill for his part of service, i.e., performance, interpretation etc. and you should get paid for the code 43239. Hospital can bill only for supplies and instruments if it has provided those. Hospital should not get paid for the global code 43239, unless your physician gets just a lumpsum contractual amount on monthly basis from the hospital, irrespective of no. of surgeries he performs in that hospital.

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