Wiki CPT 99220

[amanda19791]

Need some advice. Say a patient came to the ED and was put under observation status(99220) and a procedure done (I&D-which was not performed by my provider) on Monday and discharge the same day. The patient returns three days later with complication and needed another I&D(which is performed by provider) and my provider uses a 99220. Should we not billed the second 99220? We received a denial stating "payment included in payment for other service/procedure.

 

[AC]

More info is needed. As far as the initial charge of 99220, if the patient was admitted for at least 8 hours, you might want to look at the OBS admit/dc same day codes (99234-99236) if your provider was the admitting provider. The payer may be thinking you are billing 2 admission charges for the same admission since no discharge code was ever billed for the first admission. If your provider was not the admitting, you may need to bill an OP code (99201-99215), an OP consult (99241-99245) or an ED code (99281-99285) depending on your provider's role.

Regarding the second admission, same thing as above. You also may need a 25 modifier on the E/M code if you billed for the procedure too. Also, were these high-complexity admissions? Make sure the MDM and documentation of hx/exam supports.