This was just published for Noridian Medicare
Medicare B News Issue 237 May 29 2007
Heading: Billing
Title: Unlisted Evaluation and Management Service CPT Code 99499
1. If an "inpatient admission" (99221, 99222, 99223 or 99291) is necessary, with all required components performed and appropriately documented, then that level of service is appropriate for billing and payment.
2. If criteria for even a 99221 "inpatient admission" are not met, but a service was necessary, and all of the required components performed and appropriately documented meet criteria for a "subsequent visit" (99231, 99232 or 99233), then that level of service is appropriate for billing and payment (even though the service is chronologically an "admission").
3. If, in what should be a very rare circumstance, an E&M service is necessary, performed and documented that does not meet even the criteria for a 99231, then a 99499 may be paid (which requires individual adjudication and pricing based on the submitted documentation).