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Consult/Initial Hosptial/Subsequent

  1. #1
    Smile Consult/Initial Hosptial/Subsequent
    Exam Training Packages
    I have a question and it is somewhat related to a question I posted under this section. I know with consults you are to code an initial hospital visit (when in the hospital) and if the pt does not meet all criteria you move to a subsequent. Here is my confusion: Lets just say I have a pt that is a consult and I find the note to be Detailed History, Detailed Examination and Moderate MDM and I believe this would get a 99221. Correct? I have someone else saying that you would move it to a subsequent level visit b/c all three have to be exact. For example a Detailed history, Detailed exam and SF/L MDM. I am under the impression that you choose the code furthest to the left and if you fall short of any of those on the left you then would move to a subsequent visit code. This is where I question a new pt visit and I have a PF history, a Detailed exam and moderate MDM I would choose a 99201 but have been told that this is incorrect and you should choose an established visit that fits. Where do I find the documentation for the correct way? I have paged through 1997 and 1995 guidelines and haven't pinpointed it. Thanks!

  2. #2
    Columbia, MO
    You must meet OR EXCEED all three of the key components so yes you code to the lowest component. You are correct.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thank you. I don't know why I keep questioning everything I do lately?! I had a dr come down on me lately for confusing a high risk pt for moderate risk pt on a note and ever since then I have myself in a darn tizzy!!

  4. #4
    Milwaukee WI
    Default Subsequent vs Unlisted E/M
    Please check with your carrier about what to code when you don't meet the three key elements for 99221. WPS has specifically instructed that we are to use the unlisted E/M 99499.

    Other carriers expect you to code the subsequent hospital visit codes: 99231-99233.

    If the patient is admitted to inpatient status in the hospital it makes no difference if they are new or established. The 99201-99205 codes are for new patient OFFICE visits - would not be used for an inpatient. Ditto 99211-99215 which are for established patient OFFICE visits.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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