Office visit code

How do I bill an office visit code that is normally a place of service 11 for a patient who was brought into our office from in-patient rehab hospital? We saw this patient for a totally different reason than why she was in rehab. Medicare denied our claim stating office visit codes are not billable for patients in an inpatient hospital setting.

re: Office visit code

re: Office visit code

[How do I bill an office visit code that is normally a place of service 11 for a patient who was brought into our office from in-patient rehab hospital? We saw this patient for a totally different reason than why she was in rehab. Medicare denied our claim stating office visit codes are not billable for patients in an inpatient hospital setting.]

re: Office visit code

The problem is you are hitting a conflict in the Common Working file that has the patient as an inpatient. The CWF is the system that CMS uses to verify a resident’s entitlement to and correct use of Medicare benefits.

re: Office visit code

Okay, so what do I do? How do I bill our office visit code? We have never seen this patient before and she was delivered to our office for a UTI. Do we also bill inpatient?? She was seen in our office?

re: Office visit code

This is from the Carrier Manual and based on this, contact your carrier or go for an appeal.
"If place of service is inconsistent with procedure code billed, then edit for consistency or compatibility between the place of service and site-specific procedure codes. If the place of service is valid but inconsistent or incompatible with the procedure billed (e.g., the place of service is inpatient hospital and the procedure code billed is office visit), then return assigned services as unprocessable and develop nonassigned services since the carrier typically will not know whether the procedure code or the place of service is incorrect in such instances".
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c26.pdf

re: Office visit code

you need to send Medical Records with appeal that should prove the medical necessity of OV and also there should be timing of office visit that should show that office visit was after discharge from hospital and reason of OV should be different.