Forum - Questions & Answers

Jun 24th, 2014 - Mand0984 11 

Hospital Billers

Are any other hospital billers not getting paid for inpatient concurrent care visits other than the first? Medicare will pay 1 and deny the rest. Any tips on how to get them to pay more than 1 visit. If more than 1 doctor sees the patient it should be payable but I know they are cracking down. Just want to get someone elses perspective.

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Jun 25th, 2014 - LBAROGIANIS 250 

re: Hospital Billers

Are you billing on a UB04? If you are billing inpatient, wouldn't you just add units to your rev code? Do you have an example?

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Jun 25th, 2014 - Mand0984 11 

re: Hospital Billers

No professional side so its going out on a 1500. For example, hospitalists sees patient, we bill 99222, then neurologists sees patient same day and we bill another visit, psych sees patient we bill another visit. A visit for each provider of care. I'm new to hospital billing so I'm still not 100% sure what I'm doing yet.

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Jun 25th, 2014 - LBAROGIANIS 250 

re: Hospital Billers

So your saying that your are billing for each of these doctors, do they work for the hospital? I was under the impression that you can bill concurrent care as long as there are no two specialist alike. Usually the admitting physicain is the main doctor and specialist bill until the patient is stable at that point. I believe you will need certain modifers. Check out A1:

Modifier “-AI,” the purpose of this modifier “AI” is to defined “Principal Physician of Record”. Modifier “AI ” must be appended to the CPT® code to identify

the physician (admitting or attending physician) that is overseeing the patient’s care from all other physicians that may be providing specialty care.

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Jun 25th, 2014 - rphelps 615  1 

re: Hospital Billers

I bill concurrent care but not on a UB. My doctor works in the clinic but sees patients in the hospital. You have to be sure you stick to your specialty with your diagnosis because two docs will not be paid for the same diagnosis on the same day. I don't have any problems i this area.

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Jun 25th, 2014 - CodapediaMsgBoard 96 

re: Hospital Billers

I would agree with this. The key is that there are different diagnosis codes for each specialist seeing the patient on the same DOS. There are scenarios where a subspecialist may need to be called in for the same DX, but those will probably go to appeal.

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