Forum - Questions & Answers

Sep 3rd, 2014 - billings123 74 

hospital

Patient seen in our office and then patient went to hospital and admitted under observation, same day. The office visit was billed first with e/m 99214 and paid.
Then a month later, the observation is also billed with 99218/99217. Now, the insurance is requesting a refund that was paid under 99214 for the following reason, "99214 WAS FOUND INCEDENTAL TO CURRENT PROCEDURE 99218".
How was this visit should have been billed? Is there a modifier needed to have "99218" paid? The insurance is telling us that no payment is forthcoming to either office and initital observtion.

Thank you.

Sep 3rd, 2014 - dsteed   141 

re: hospital

Observation should have been billed, taking into consideration the work done in the office. Generally limited to the provider billing one E & M code for any calendar day.

Sep 4th, 2014 - billings123 74 

re: hospital

Yes, observation was billed a month later without knowing that an office visit has already been billed and paid. Now, the insurance company is asking for a refund of the payment paid from the office visit and when we called about the observation, we were told no payment. We told them that we disagreed and to pay for the observation.

Sep 4th, 2014 - dsteed   141 

re: hospital

You will likely need to refund the office visit & then rebill for the observation. Does your contract with the payer address this type of issue? Not likely they will pay for the observation until the refund has been processed.

Sep 4th, 2014 - billings123 74 

re: hospital

Thank you. Understand.



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