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When documentation doesn't meet 99221?

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    Medical Coding Books
    This was just published for Noridian Medicare

    Medicare B News Issue 237 May 29 2007
    Heading: Billing
    Title: Unlisted Evaluation and Management Service CPT Code 99499
    1. If an "inpatient admission" (99221, 99222, 99223 or 99291) is necessary, with all required components performed and appropriately documented, then that level of service is appropriate for billing and payment.

    2. If criteria for even a 99221 "inpatient admission" are not met, but a service was necessary, and all of the required components performed and appropriately documented meet criteria for a "subsequent visit" (99231, 99232 or 99233), then that level of service is appropriate for billing and payment (even though the service is chronologically an "admission").

    3. If, in what should be a very rare circumstance, an E&M service is necessary, performed and documented that does not meet even the criteria for a 99231, then a 99499 may be paid (which requires individual adjudication and pricing based on the submitted documentation).

  2. #12
    Default
    Do you have a link so I can see this info online?
    Thank you!

    Quote Originally Posted by jllgood View Post
    This was just published for Noridian Medicare

    Medicare B News Issue 237 May 29 2007
    Heading: Billing
    Title: Unlisted Evaluation and Management Service CPT Code 99499
    1. If an "inpatient admission" (99221, 99222, 99223 or 99291) is necessary, with all required components performed and appropriately documented, then that level of service is appropriate for billing and payment.

    2. If criteria for even a 99221 "inpatient admission" are not met, but a service was necessary, and all of the required components performed and appropriately documented meet criteria for a "subsequent visit" (99231, 99232 or 99233), then that level of service is appropriate for billing and payment (even though the service is chronologically an "admission").

    3. If, in what should be a very rare circumstance, an E&M service is necessary, performed and documented that does not meet even the criteria for a 99231, then a 99499 may be paid (which requires individual adjudication and pricing based on the submitted documentation).
    Carrie, BS, CPC

  3. Default
    I found the article online....

    https://www.noridianmedicare.com/sha..._CPT_99499.htm

    Though I see at the bottom it states, "Applies to the states of"

    My state isnt listed, is yours? Now what???

  4. #14
    Default
    I got it to work. No--my state was not listed. Anyone have suggestions for those of us whose states are not listed on the article?

    I found this website earlier when I was researching, but coudn't find the article. I had to click on the "I accept" button and then the document came right up.

    Here's the address for the document. I'm not sure if it will work, but it's worth a try:
    https://www.noridianmedicare.com/sha..._CPT_99499.htm

    Thanks
    Last edited by cdcpc; 10-07-2008 at 12:58 PM. Reason: IL was not listed
    Carrie, BS, CPC

  5. #15
    Default
    I just noticed the link I posted showed up exactly the same as yours. I'm not very internet-saavy. Sorry!
    Carrie, BS, CPC

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