Wiki What to charge when 99221 requirements not met?


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What code would I use when my physician admits the patient as an inpatient to the hospital, howver, 99221 requirements are not met. He gives an expanded problem focused HPI, expanded-problem focused exam, and moderate decision making.

This is a Medicare patient, any documentation available that addresses this?

Thank you,
Check to see if the documentation qualifies for time based coding. Meaning the total F2F time between the provider and the patient is documented, the percentage of counseling and/or coordination of care is indicated as being more than 50% of the total visits F2F time, and a summary of the topics discussed. If it doesn't qualify for time based coding, you can not code a service.
Jen Godreau, CPC, CPMA, CPEDC
The Coding Institute
First and foremost, i personally get guidance from your MA,. I've seen some who say bill the unlisted code 99499 and some who say you'd bill the subsequent hospital visit code based on documentation.
The February 2012 issue of Coding Edge features an article titled "Use Subsequent Care Codes for Low-level Initial Visits". That straightened it out for me.
Based on which Medicare Intermediary? I am curious.. :)

This is still a billable visit - our MAC, Novitas (formerly Highmark Medicare Services) advises to use the appropriate subsequent level based on the documentation when it does not meet any of the initial inpatient levels. I had heard before that other MACs say to use the unlisted 99499. I would contact your MAC and verify what they would want you to use.