99223 vs 99232

[mtsoldevila]

Can I downcode initial CPT 99223 to a subsequent code 99232 and rebill the claim as a corrected claim if the dr. notes doesnt support the 99223. I have downcoded 99233 to 99232, but never an initial code to a subsequent. Is this allowed?

 

[thomas7331]

Per CMS' publication MM7405, physicians who would previously have reported inpatient consultation codes may substitute the subsequence care visit codes if the elements for an initial inpatient visit code have not been met (see below). I have not seen any guidance from CMS that addresses this situation in the case where it applies to the admitting physician, however I recall some articles suggesting that if an admitting physician does not meet the requirements for 99221-99223, then the most appropriate code would be the unlisted E/M code 99499.

In situations where the minimum key component work and/or medical necessity requirements for initial hospital care services are not met, subsequent hospital care CPT codes (99231 and 99232) could potentially be reported for an E/M service that could be described by CPT consultation code 99251 or 99252.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7405.pdf