Wiki E/M billing

[keleigh237]

my provider needs to see an established patient this week for an inspire activation. This patient is currently inpatient at a hospital. What is the appropriate code he needs to use for a level 5 visit in this situation?

 

[Pam Warren]

I'm not sure if you mean E&M code or diagnosis code, so I'll comment on both. Is he seeing the patient in the hospital? if so, there's no 'level 5' for an inpatient E&M visit with POS 21. Depending on the situation, (and payer) 99223 or 99233 would be the highest level code you can report....IF the documentation supports that level of visit. Based on what you're telling me, unless your provider can substantiate through documentation of the visit a high complexity condition with high medical decision making (and if billing an initial hospital visit, also a comprehensive exam), you're going to have difficulty with supporting that higher level of code.

The inspire activation is for treatment of obstructive sleep apnea, correct? I would assume that would be the diagnosis code, if it's been so stated by the physician. Hope this helps.