Wiki CPT code set 99234-99236

tracylc10

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Good morning Coders!!

I am confused a bit with these codes. This code set is titled Observation/Inpatient visits: Admitted/Discharged on Same Date. I have been told that observation visits are outpatient since I started working here. Looking at these codes, I believe that these are in the inpatient setting. I do not think that these codes can be either inpatient or outpatient. My manager says that they can be either or.

I apologize if this is confusing, just need some clarity on these codes.

Thank you.
 
These should be used if a patient is admitted and discharged on the same day whether or not they are admitted to Observation or Inpatient status. What matters is that they were admitted and discharged on the same calendar date by the same Physician.
 
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These should be used if a patient is admitted and discharged on the same day whether or not they are admitted to Observation or Inpatient status. What matters is that they were admitted and discharged on the same calendar date by the same Physician.


Thank you, I understand that, but rather my question is can this code be billed with a place of service of either inpatient or outpatient? We have a single payer that has denied several charges for these codes that were billed with the place of service as outpatient hospital. Other payers are paying it being billed as outpatient.
 
It sounds like that particular payer might have a policy regarding these codes.

If you cannot find any policy in writing stating that these codes can only be used inpatient I would try appealing the denials with a copy of the CPT book page highlighting the code description which clearly states they are to be used for Observation or Inpatient status.

Good luck!
 
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