Wiki What to Bill?

[krugerc]

Our hospital recently open up an inpatient Psych ward.
I have some Initial Day visit notes that are not billable as 99221 (don't meet documentation requirements) and I was told to bill 99221 at $0.
Is there anything else that I could bill?
Thanks.

 

[1073358]

You would not bill it at 0$. How would you get paid?? You can bill a 99499 and submit documentation. Bill at the same price as 99221 and see if you can get it paid.

I have also heard of people dropping down to the 99231-99233 but that is questionable of if its really appropriate or not.

Does he meet criteria for 90801?

 

[KimberlySherman]

Use subsequent inpatient codes

We have trained extensively on E/M coding in my department, and the instructors have told us to use the subsequent inpatient codes (99231-99233) when the admit E/M does not meet the criteria for 99221. I work in California.

From what I have seen online, some payors may prefer the unlisted E/M code 99499 in this scenario, while others prefer the subsequent code. Medicare published this guideline in May 2007 (Medicare B News): "CPT code 99499 is never to be used to interpolate between two levels of E/M service within a category or subcategory. Rather the next lower code for which all criteria are met is the appropriate choice."

I am curious as to how to code an admit E/M by the principal physician of record for Medicare or an HMO when the criteria for 99221 are not met and -AI is required. I have not seen this situation yet in my inpatient coding.

 

[krugerc]

I don't do our inpatient billing so I forwarded your e-mail to the people who do it.
Thank you.

 

[RLXE2004]

I beleive you can use 90801

 

[napahny@aol.com]

We code 90801 if the psychiatrist performed the admission assessment on the day of admission ( documentation need to meed the criteria, see CPT book, Psychiatry section)