Wiki Office Visit while in Inpatient Rehab

[mjlan_72@yahoo.com]

We billed Medicare an E/M office visit. Medicare denied stating patient was inpatient rehab facility. Per MCR portal he was in inpatient rehab during the DOS we billed. We then sent the claim to the inpatient rehab. They denied stating to bill the insurance. We appealed to Medicare and they denied the appeal. We then sent out corrected claim with POS 21. Medicare denied again as The procedure code/type of bill is inconsistent with the place of service. Anybody have any advice?

 

[thomas7331]

You'll need to select the correct CPT code for E&M of an inpatient, which would likely be in range 99221-99233.

 

[mjlan_72@yahoo.com]

Even though the patient was seen in the office ?

 

[emarshall]

Even though the patient was seen in the office ?

Yes you need to bill inpatient cpt codes foe the inpatient POS. The Office EM codes that you billed are billed in POS 22.

 

[gailg929]

Wouldn't the POS be 61 ? for Inpatient Rehab Facility? I still question the use of inpatient EM codes. Isn't that fraud? The patient was seen in our office and our MD has nothing to do with the agreement made between another Provider and the Facility. Our office is having the same problem. Medicare (verbally) told us to appeal. We do, and it is still denied.
Is there anything in writing that billing an office visit as an I/P EM code is the correct way to bill these out?