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denial

  1. #1
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    Worcester Ma #50805
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    Default denial
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    pt has been admitted and is inpatient status,MD consults and decides to do surgery spends 35 minutes with pt. 99252-57 is what I'd like to code but making a decision for surgery seems a little more complexed than what's in this code or can i use cpt 99233-57 Subsequent Hos. Care because Md was preforming a hospital visit with a desicion for surgery??

  2. #2
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    Greeley, Colorado
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    Is this a Medicare patient?
    Lisa Bledsoe, CPC, CPMA

  3. #3
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    Worcester Ma #50805
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    yes this is a medicare pt

  4. #4
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    Worcester Ma #50805
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    Quote Originally Posted by Lisa Curtis View Post
    Is this a Medicare patient?
    yes this is a medicare pt.

  5. #5
    Location
    Greeley, Colorado
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    Then why not use an initial inpatient visit 99221? That is if the time is documented correctly.
    Lisa Bledsoe, CPC, CPMA

  6. #6
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    Worcester Ma #50805
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    Quote Originally Posted by Lisa Curtis View Post
    Then why not use an initial inpatient visit 99221? That is if the time is documented correctly.
    I thought that code is for the admitting physician this pt has already been admittedand is being seen in hospital room

  7. #7
    Location
    Columbia, MO
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    Starting Jan 1 2010 Consultation codes are invalid when submitted to Medicare. The admitting physician should have use an AI modifier on his 9922x code and your physician will use a 9922x code as well then use the 57 modifier with that.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
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    Worcester Ma #50805
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    Quote Originally Posted by mitchellde View Post
    Starting Jan 1 2010 Consultation codes are invalid when submitted to Medicare. The admitting physician should have use an AI modifier on his 9922x code and your physician will use a 9922x code as well then use the 57 modifier with that.
    this was from a denial in oct 09

  9. #9
    Location
    North Carolina
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    Quote Originally Posted by john maceachern View Post
    pt has been admitted and is inpatient status,MD consults and decides to do surgery spends 35 minutes with pt. 99252-57 is what I'd like to code but making a decision for surgery seems a little more complexed than what's in this code or can i use cpt 99233-57 Subsequent Hos. Care because Md was preforming a hospital visit with a desicion for surgery??

    If there was a true request for consultation, your provider can bill an inpatient consultation (since this is 2009-Medicare I presume) with a modifier 57.

  10. #10
    Location
    Greeley, Colorado
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    John - the ladies above are correct. I thought you were talking about 2010.
    Lisa Bledsoe, CPC, CPMA

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