Wiki Coding 99199 for unlisted facility charge

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Willow123

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Hello:

I am reviewing a claim for one of our CM nurses. The provider is billing the following codes on a CMS-1500 HCFA form:
64483
Q9966
S0020
J1040
A4550
99199

We are questioning the 99199. Per appeal letter, the provider is indicating this is a facility fee. The physicians rents the medical office space that was used to perform the above services. They also stated, "we purchase all of our own drugs, supplies and equipment.

Can anyone please tell me if 99199 is appropriate to bill in conjunction or what alternative code should the provider had utilized.

Your help is greatly appreciated.
 
Well it looks like they were billing for the drugs and supplies already, so that would be double-billing, plus there are HCPCS codes for that stuff, so an unlisted code would be inappropriate anyway (unless it's an unlisted drug, but there's a J-code for that too). As far as the room charge, I dont think that's appropriate either, the use of the room should be included in the fee for the procedure I think. Anybody else know of a code that a facility would bill for this type of charge?
 
Hi Aaron. I agree with you. Hopefully we get some more feedback.

Thank you so much for responding, this helps me out alot.
 
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