Wiki What to charge when 99221 requirements not met?

[Mklaubauf]

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,
Marci

 

[Jennifer Godreau]

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

 

[rthames052006]

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.

 

[laurenkrass]

Medicare allows you to code 99232 when you don't meet the documented criteria for 99221.

 

[Love Coding!]

Medicare allows you to code 99232 when you don't meet the documented criteria for 99221.

Based on which Medicare Intermediary? I am curious..

 

[solocoder]

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.

 

[jvanek82]

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.