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Thread: Coding Question

  1. #1
    Join Date
    Apr 2007

    Default Coding Question

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    I keep getting rejections on codes 99254 and 99255 when the admitting physician bills with code 99235. Is there any other way to bill these codes to help get payment for our physicians? According to Medicare, when the admitting phys bills these observation codes, no other physician charges will be paid. If any has any input please let me know if there is any thing I can do.

    Tosha Moore, CPC, CPMA

  2. #2


    Are these patients in admitted and discharged the same day? Your are billing two kinds of visits I think that is why they are kicking it out. Per CPT guidelines you only bill 99234-99236 if patient is admitted and discharged the same day. If the patient is obervation for more than the first day I code from 99218-99220 and 99217, if inpatient I use 99252-99255 if it isn't Medicare. If it is inpatient and is Medicare I code 99221-99223. I believe I am coding correctly, anyone have any other imput?

  3. #3
    Join Date
    Apr 2007


    Thank you. The problem with my question is that the admitting physician is not one of our docs. We don't know what they bill until we get the rejection back. Any IDEAS!!!!

  4. #4
    Join Date
    Apr 2007
    Hartford, CT


    The first problem is that Medicare is no longer paying consult codes (99241-99245 or 99251-99255), if these vists are after 1/1/2010 they will always be rejected by Medicare. Per Medicare guidelines (NGS anyway) an initial inpatient visit is to be coded as 99221-99223 (the admitting M.D. adds and AI modifier), observation is to be coded with 99211-99215 and ER visits are coded with 99281-99285. You don't need to know what the admitting doc charged, you only need to know if the hospital billed as Inpt, OP or ER, it's the place of service that matters, not what the other doc billed. Hope this helps a little

    Doreen, CPC

  5. #5
    Join Date
    Apr 2007


    Thank you so much!!!!!

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