gonzalezm27
New
I am having an issue with a claim that was recently reviewed by Cotiviti the RAC (Recovery Audit Contractor) for CMS in our region in Texas. The patient was inpatient POS 21 at the time and the provider billed CPT 99223 w/90833. According to the recovery EOB from Medicare the claim is being denied indicating reason code N535 "Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service. I have done research regarding billing CPT 90833 with E&M codes and nowhere does it state CPT 90833 can't be billed inpatient POS 21. I have also reviewed the LCD for our area and nothing states that CPT 90833 is non billiable with CPT 99223. The providers documentation specifically states "17 minutes of supportive psychotherapy provided to patient. The diagnosis code billed was R41.10. The RAC contractor did allow for a discussion period however the billing dept missed the opportunity window. At this point I would like to know if anyone else is having this issue if so what did you do?
Thanks
Thanks