Wiki denial

[john maceachern]

pt has been admitted and is inpatient status,MD consults and decides to do surgery spends 35 minutes with pt. 99252-57 is what I'd like to code but making a decision for surgery seems a little more complexed than what's in this code or can i use cpt 99233-57 Subsequent Hos. Care because Md was preforming a hospital visit with a desicion for surgery??

 

[Lisa Bledsoe]

Is this a Medicare patient?

 

[john maceachern]

yes this is a medicare pt

 

[john maceachern]

Is this a Medicare patient?

yes this is a medicare pt.

 

[Lisa Bledsoe]

Then why not use an initial inpatient visit 99221? That is if the time is documented correctly.

 

[john maceachern]

Then why not use an initial inpatient visit 99221? That is if the time is documented correctly.

I thought that code is for the admitting physician this pt has already been admittedand is being seen in hospital room

 

[mitchellde]

Starting Jan 1 2010 Consultation codes are invalid when submitted to Medicare. The admitting physician should have use an AI modifier on his 9922x code and your physician will use a 9922x code as well then use the 57 modifier with that.

 

[john maceachern]

Starting Jan 1 2010 Consultation codes are invalid when submitted to Medicare. The admitting physician should have use an AI modifier on his 9922x code and your physician will use a 9922x code as well then use the 57 modifier with that.

this was from a denial in oct 09

 

[RebeccaWoodward*]

pt has been admitted and is inpatient status,MD consults and decides to do surgery spends 35 minutes with pt. 99252-57 is what I'd like to code but making a decision for surgery seems a little more complexed than what's in this code or can i use cpt 99233-57 Subsequent Hos. Care because Md was preforming a hospital visit with a desicion for surgery??

If there was a true request for consultation, your provider can bill an inpatient consultation (since this is 2009-Medicare I presume) with a modifier 57.

 

[Lisa Bledsoe]

John - the ladies above are correct. I thought you were talking about 2010.