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Thread: 99215 billed before admission ?

  1. #1
    Join Date
    Apr 2007

    Default 99215 billed before admission ?

    AAPC: Back to School
    Can someone please clarify this ? http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
    F. Initial Hospital Care Service History and Physical That Is Less Than Comprehensive
    When a physician performs a visit or consultation that meets the definition of a Level 5 office visit or consultation several days prior to an admission and on the day of admission performs less than a comprehensive history and physical, he or she should report the office visit or consultation that reflects the services furnished and also report the lowest level initial hospital care code (i.e., code 99221) for the initial hospital admission. Contractors pay the office visit as billed and the Level 1 initial hospital care code.

  2. #2
    Join Date
    Apr 2007
    Boston, MA


    What it means is that if your provider is admitting a patient s/he has recently seen and billed a level 5 visit/consult for, then this should be considered. At the time of admission, the history and exam are less than comprehensive and reference is made to the prior assessment during the recent visit. Since your provider did not do a comprehensive history and exam when admitting the patient, s/he cannot bill higher than a 99221. However, usually in order to bill a 99221 you need to document a detailed history and exam. If the patient had a recent level 5 visit/consult they seem to reduce the "detailed" requirement to "less than comprehensive" with reference to the prior documentation from the recent level 5 encounter.
    That is my interpretation. Hope it is useful.

  3. #3
    Join Date
    Apr 2007


    Yes that helps.. thank you

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