Forum - Questions & Answers

Sep 16th, 2011 - coder007 5 

What modifier to use for inpatient services?

What modifier should we use so Medicaid would not deny a hospital claim charge noting that it's included in a surgical/anesthesia fee. For example when the doctor admits his patient to the hospital,and later finds out that he needs surgery. The surgeon operates on the patient & the doctor makes his daily hospital visits & discharges the patient. When I billed the claim, medicaid paid just for the admission and denied the rest because it is included in the surgery/anesthesia fee.

I know that I cannot bill with mod. 55 since that must be used with a surgery code only, and here's no "split billing" scenario.

Do I need to re-submit the claim with documentations showing that services were done on different days by 2 diff. doctors? Please help.

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Sep 16th, 2011 - jschmutz   323 

re: What modifier to use for inpatient services?

Need more info.

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Sep 20th, 2011 -

re: What modifier to use for inpatient services?

Its all about the diagnosis- your doc needs to use a medical diagnosis, not the reason for the surgery

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