observation denials

We have started to receive denials from medicare for observation codes stating another provider was paid. I billed a 99236 for our Dr. and per medical records he did the H & P and Discharge but was denied due to another provider paid. I checked and the other physician is a specialist and did a consultation. The AI code for principal provider is only for the inpatient codes how should this have been billed so both Dr.s would be paid? any suggestions would be appreciated.

re: observation denials

Did you bill with an outpatient place of service? Did you bill a different diagnosis? That's all I can think of that would make them deny.

re: observation denials

Correction 99236 can be outpatient or inpatient.

re: observation denials

yes we billed outpatient place of service but when I called medicare they said another Dr. was paid for the same code on that day. That Dr was a specialist doing a consultation. I think they billed the wrong code. I am appealing with our notes showing my Dr did the H&P and discharge and was the provider assigned. We have several patients that this is all of a sudden happening to when in outpatient at the hospital. Thank you for responding

re: observation denials

I can assure you they will reimburse on only the first received of any physician billing for E&M codes - at least that is our experience. In our MH setting, if the nursing staff try to bill a 99211 on the same day the Clt/Pt also sees the doctor/prescriber, whichever of the two contacts arrives at CMS first is the one paid - the other contact/bill is NOT, even if two completely different types of contact occurred.
If others have experienced otherwise, I'd be interested in knowing how they billed and how they documented for which they received reimbursement for both??

re: observation denials

THe consultant should not have used the initial admission code. The consultant bills with new or established patient codes, 99201--99215 for Medicare and other payers that don't recognize consults. (99241-99245 for those that do).

That's cold comfort, but I would try to talk to the consulting office so it doesn't happen again.