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Thread: What to Bill?

  1. #1
    Join Date
    Apr 2007

    Default What to Bill?

    AAPC: Back to School
    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?

  2. #2


    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?

  3. #3
    Join Date
    Apr 2007
    San Diego, California

    Exclamation 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.

    Kimberly A. Sherman, MA, CPC
    Multi-Specialty Physician Coder/Entrepreneur

  4. #4
    Join Date
    Apr 2007


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

  5. #5


    I beleive you can use 90801

  6. #6
    Join Date
    Apr 2007


    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)

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