Wiki Observation discharge 99217

[vcar]

Hi everyone.

We have a patient that was admitted to observation by our provider via phone on 5/8/20 for Multiple Sclerosis icd-10 G35. Provider did not dictate H&P until 5/9/20. On 5/9/20 patient was discharged from observation and discharge summary dictated. Only 99217 with pos 22 was billed. Indiana Anthem Medicaid has denied the 99217 indicating it's not a covered service. Code 204-SVC/EQUIP/DRUG NOT CVD UNDER PLAN. Any idea why?

Thanks

 

[SharonCollachi]

If the DOS of the H&P was 5/9, and the DOS of the discharge was 5/9, then you cannot use the discharge code, because those are day management codes.

If the DOS are the same, look at 99234-99236. However, some insurances don't accept those codes, and you only get the admit.

When you said "only 99217... was billed", if you mean that an admission was NOT billed at all, that is probably the problem. You can bill an admission without a discharge, but if no one is billing an admission, you cannot bill a discharge (in my experience).

 

[vcar]

Thanks