Wiki "Crosswalk" codes from 99251/99252 to 99221

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Hi all, does anyone have suggestions or hard documentation that clarifies the crosswalk from 99251/99252 to Inital Hospital?

If the documentation supports 99251 or 99252, but does not meet the definition of 99221 (detailed), what gets billed? (Someone in another post suggested 94999). Maybe Subsequent Hospital visits?

We can continue to educate the providers, but what if the elements of E/M do not meet at detailed for Initial?
 
crosswalk

During the NGS talk today, they said DO NOT use 99499. They want the 99231 or 99232 used, whichever fits the documentation and medical necessity. I don't know what the other carriers are saying but it would be nice if they all said the same thing for once!!
 
I agree with Cheermom. Our Medicare carrier also recommended staying away from 99499...if at all possible. Currently, the sub. visits codes follows in line with the current guidelines if the encounter doesn't result in an admission or "request for evaluation"....

Chapter 12 (currently)...

"Physicians that participate in the care of a patient but are not the admitting physician of record should bill the inpatient evaluation and management services codes that describe their participation in the patient’s care (i.e., subsequent hospital visit or inpatient consultation"...... (now crosswalking with 99221-99223).

I'm going to seek further clarification from our local Medicare director since our carrier is still somewhat vague in this one area.
 
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If you read the transmittal it says to follow the E&M guidelines for the appropriate level. In otherwords there is no crosswalk. You must meet the 95 or 97 guidelines criteria for a 99221-99223, and you should not be using the unlisted code. The physicians will need to document for the inital inpatient levels to be reimbursed.
 
Medicare no longer recognizing consultations

Medicare is no longer recognizing consultations (including inpatient). Instead, the provider is to bill with an Initial Hospital Care code. Initial Hospital Care code elements (99221) begin at Detailed/Detailed....

What is the documentation supports Expanded Problem Focused/Expanded Problem Focused...?

Would we report Subsequent Hospital visit 99232?
 
Less than Detailed Hx or Exam

According to MY Medicare carrier, if the initial hospital visit documentation does not meet the standard for 99221, then you should use the unlisted E/M procedure code 99499 and submit with documentation.

When CMS has said not to use 99499 I think they mean for ALL hospital consults. In my experience, most of documentation for inpatient consultations I've seen would meet the guidelines for 99221-99223. BUT for those that do not (e.g. dermatologist called to evaluate a rash ... problem focused exam) then we would use 99499.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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