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Wiki EPF Hx - Inpatient initial visit

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sivagurulingam

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Hi all please clarify me on how to code when EPF hx in the initial inpatient visit. CPT code 99221 state "Detailed hx and exam and SF/Low MDM". How to code this visit ?. Is there any specific guideline ?
 
I don't think there is any specific guidance on your question. However, I do think you have two options.
My first one would be 99499 ? unlisted E&M and submit the medical records. This is my first choice.
However, I do think there could be a valid argument for 99221-52 ? reduced service and still submit the medical records.
I was trying to think if you could use an argument for the ?half way? point. Meaning, if the minimum has not been reached, can you still get the minimum code. But I think no, you can?t.
So my first choice is 99499 and submit the medical records.
 
cjhalk@yahoo.com said:
I don't think there is any specific guidance on your question. However, I do think you have two options.
My first one would be 99499 ? unlisted E&M and submit the medical records. This is my first choice.
However, I do think there could be a valid argument for 99221-52 ? reduced service and still submit the medical records.
I was trying to think if you could use an argument for the ?half way? point. Meaning, if the minimum has not been reached, can you still get the minimum code. But I think no, you can?t.
So my first choice is 99499 and submit the medical records.
Click to expand...

The 52 modifier cannot be used on E&M codes. The only possible answer is to bill thus as unlisted E&M. Or the coder can return the note to the provider to gave it amended with any additional information that may have been accidentally omitted.
 
mitchellde said:
The 52 modifier cannot be used on E&M codes. The only possible answer is to bill thus as unlisted E&M. Or the coder can return the note to the provider to gave it amended with any additional information that may have been accidentally omitted.
Click to expand...

Awesome. Thank you. I didn't know modifer 52 couldn't be used on E&M. Thank you.
 
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