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Thread Topic: on call billing
Topic Originator: michelle
Post Date August 11, 2006 @ 10:37 PM
on call billing

August 11, 2006 @ 10:37 PM Reply  |  Email Friend   |  |Print  |  Top

My dr is an oral surgeon,and when he is on call for the hospital on the weekends he thinks that he can bill more than a 99252 for a hosp consult. because it is after hours and he has to leave his house to go do this on consult.would love some advice is there another code or modifier to use to get paid more?

August 23, 2006 @ 11:01 AM Reply  |  Email Friend   |  |Print  |  Top

How about this?

99026  Hospital mandated on-call service;each hour

This is not my area of expertise, but I see that no one has replied yet.  My code books make this statement:

"The procedures 99000 thru 99091 provide the reporting physician with the means of identifying the completion of special reports and services that are an adjunct to the basic services rendered."

Whether or not ins. will pay for it is another story.

August 28, 2006 @ 11:23 PM Reply  |  Email Friend   |  |Print  |  Top

check out 99053, and see if that will help.

September 5, 2006 @ 1:19 PM Reply  |  Email Friend   |  |Print  |  Top

He can bill whatever he wants but the determining factor is the individual insurance contract.  Read those and they will state that they will pay for this or not.  You can attempt to renegotiate this at the next contracting time (yeah right) but I wouldn't hold my breath.  We only have one contracting party (BC/BS of Montana, and not the whole BC/BS agency)  that pays 99058 with conditions, but not 99050, 99052, or 99054 as they are considered inclusive in services rendered.

Dan Young
September 9, 2006 @ 3:39 PM Reply  |  Email Friend   |  |Print  |  Top

When in doubt on what the insurances will pay:  CALL them.  If necessary you might be able to work out a temporary compromise with the individual insurance companies to carve out a special payment program for your provider.

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