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May 29th, 2014 - blanche22 20 

denied another provider paid

I started to receive multiple denials this year for reason code CO-B20 for another provider paid for same code on same date of service. This is coming from Medicare and a few from Nevada Medicaid. Since the provider I bill for is the primary care or principal provider of record I haven't used a modifier. unless it is the admission and I use the AI. Medicare directed me to instructions that say modifier AI can also be used for subsequent visits. The other providers being paid are specialists. I am confused on the use of the modifiers and if I should be using them for all his visits.
Medicaid couldn't give me an answer on their denial. I received a denial for 99308 and that a specialist was paid for the same code same day.
Should I have used a modifier or should the specialist be using a modifier?

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May 29th, 2014 - LBAROGIANIS 250 

re: denied another provider paid

IT APPEARS THAT YOU SHOULD BE USING AI, SEE BELOW:

AI- IS THE PRINCIPAL PHYSICIAN OF RECORD

CPT® 99308 IS Nursing fac care subseq

Are you billing for a nurse and not a physician? Just curious.



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May 29th, 2014 - blanche22 20 

re: denied another provider paid

I bill for the Physician, internal medicine. I called medicare reopening and added the modifier AI to one of the denials and am waiting for it to process.
They changed the usage of the AI and I can't figure out when that happened or how I missed this. I have been billing for him the last 8 years and this just started to happen with this code. Thank you for your input. I am thinking this is what I need to be doing from now on.

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May 29th, 2014 - rphelps 615  1 

re: denied another provider paid

I have never used AI on subsequent visits, only the initial admit or consult. Are you sure you are not using the same diagnosis as another physician. That has always been the determining factor for more than one physician getting paid on the same date of service.

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May 30th, 2014 - blanche22 20 

re: denied another provider paid

Yes they told me that the diagnosis is also why it is denying.
How do I correct what I am doing to get his claims paid? I never had so many before. He may see that patient for a full month then gives me his information to bill. How am I to know what the other provider is coding? I only ever used the AI for admissions but per the medicare description for the correct use I can use it for subsequent as long as he is the principal physician of record.

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May 30th, 2014 - rphelps 615  1 

re: denied another provider paid

First of all you need to bill sooner. I bill within 2 days of the doctor signing off. First come, first serve. The only thing I can tell you is stick to your specialty.

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Jun 2nd, 2014 - blanche22 20 

re: denied another provider paid

I understand that we should bill sooner but I have to wait for the Dr. however, I am adding the modifier AI to the dates not paid and the first claim I called reopening on has paid. apparently they made a change in the use of the AI modifier. Instructions are found on Noridian website. just searched for AI modifier.

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