Wiki Claim Denial

[gemini jordan]

Hello
I'm working a Coding denial claim was billed with 99225 on CMS 1500 for dates 4-2-18 & 4-3-18 with no discharge date & its denying for Inappropriate POS should the place of service be billed with 22 even though patient had surgery & was in the hospital according to Discharge summary 4-1-18/4-3-18??? Please Advise

 

[Chelle-Lynn]

You are billing with an observation code 99225 but you are indicating that the patient was in the hospital from 04/01 - 04/03 which would indicate 2 days of service. Observation care is 24 hours defined as the physician anticipated the patient to improve or complete treatment within 24 hours or less. Sounds like the issue is the timeframe and CPT Code.

If the patient was in observation past 24 hours was there a reason that the patient was not converted to inpatient status? Possibly the patient should be billed as inpatient and not observation.

However if the patient was truly in observation status then, yes, 99225 would be billed with POS 22