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nyyankees

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We have a Dr who has been using 99239 (Hospital Discharge) for some of her patients. We have an authorization for this from their ins co's BUT what's happening is:

The patient is having surgery (with a differnet DR) and staying LESS than 24 hours in the facility and the surgeon/anestesiologsits are billing out their cliams as Outpatient. We are now, of course, receiving denials for no authorization. (I am assuming because it should be billed as an outpatient E/M service - not sure though).

Could you please point mt in the right direction as to how to bill this visit correctly (as she is doing the service - I think just using the wrong E/M code) and where I can find some literature/documentation to support these findings when I go back to her and ask her to change/update her E/M selection.

Thank you. :D
 
Can you give a little more detail, I am having a hard time seeing the whole picture here.

If you could walk us thru what is happening from start to finish that would be very helpful.

Thanks

Laura, CPC, CEMC
 
katmryn78 said:
Can you give a little more detail, I am having a hard time seeing the whole picture here.

If you could walk us thru what is happening from start to finish that would be very helpful.

Thanks

Laura, CPC, CEMC
Click to expand...

She's billing the inpatient discharge CPT while the surgeon that performed the surgery on the patient (she was just asked to see the patient) is using the Outpatient Place of Sevice because the patient was NOT in the facility for more than 24 hrs.

I am still waiting on her ofiice notes (we're a billing service) to get a better idea of what she did (consult, office visit, etc.).

I would like to know where I can get some information on the rules/regulations on a patient stay for less than 24hrs in regards to documenting/billing the proper E/M visit.

I am probably going to have to go back to her to change her E/M code but wanted some literature about WHY she should be changing her E/M code. She did this on several patients and it was brought to my attention to research the proper way to code this sceanrio.

Hope this clarifies what I'm looking for. Thanks.
 
So she didn't admit the patient, the surgeon just asked her to clear them before they left?

Where was the patient actually seen? It is possible the surgery is being billed with the wrong place of service, but not a very good possibility. We have had cases where the patient only has outpatient coverage so the doctor gets the auth and bills his part outpatient even though it was done inpatient. This is obviously wrong but it does happen.

If the patient was not an inpatient, she would just use the 99212-99215 or if it was a consult (doesn't sound likely though) 99241-99245.

Laura, CPC, CEMC
 
Thanks. Are there any articles/guidelines on this scenario? Is it the fact she did not admit the patient that sets the pace? Just want to make sure she understands why I want to change things up (on several patients of hers). :)
 
First thing is you need to identify where the patient was. Once that is determined then you would follow the applicable guidelines for that setting.

I hate to be vague but until you know for sure what was done and where there really aren't any guidelines to link to.

One question, does she actually have the time documented to support the 99239?

Laura, CPC, CEMC
 
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