Forum - Questions & Answers

May 1st, 2014 - LauraLou

Correct coding pro fees

Medicare patient. Patient ip at another facility, but not discharged. Patient sent to our physicians office for exam. Our physican charged CPT® 99203. Then 2 hrs later performed at our facility an angio (op procedure). Pt was then sent back to the other facility. Medicare took back our payment from CPT® 99203 stating we used the incorrect pos; because pt was an ip at the another facility. Can we get paid for this visit before the op procedure?

May 1st, 2014 - dsteed   141 

re: CORRECT CODING PRO FEES

For a Medicare patient that is inpatient at another facility, you must bill that facility for the cost of the service. A hospital that has a patient inpatient status is financially responsible if the patient must be sent to another hospital for a service. These type of arrangements should be made in advance or the paper work sent with the patient for providing the service should indicate that billing goes to hospital A. Registration at your hospital should show hospital A as the guarantor.

Hospital A will include the service at hospital b on their UB. When these steps are missed, it is very possible that hospital A has already billed for their inpatient services without including these charges.

May 1st, 2014 -

re: CORRECT CODING PRO FEES

We did bill Hospital A for the procedure that was done at our facility, but for the professional fees; we should be able to bill Medicare directly for those. The surgeons claim was processed and paid by Medicare but not CPT® 99203. Since the patient came directly from Hospital A to see the physican in his office then had the procedure; shouldn't we be able to bill for the office visit (99203) as a POS 22 (his office is in our hospital) with a Modifier 57???

May 2nd, 2014 - dsteed   141 

re: CORRECT CODING PRO FEES

If Medicare is assuming the 99203 to be the pre-op component of the service, you will need to discuss this with your MAC. Modifier 57 appropriate only if the service has a 90 day global.



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