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When documentation doesn't meet 99221?

  1. Default When documentation doesn't meet 99221?
    Medical Coding Books
    I was wondering if anyone has any information on what to do when an initial hospital visit does not meet the criteria of the 99221? Is it supposed to be downcoded to a subsequent (99231-99233) visit? I can't find any clear documentation on this issue.

    Thanks!

  2. #2
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    99221 is for the first admittance visit then you would use 99231-99233 for subsequent visits. If patient is discharged same day use 99234-99236. Hope this helps.
    nichole

  3. Default
    Yes, but if the history doesnt even meet detailed what are the guidelines? Don't bill? Use unlisted code? Use subsequent??

    Thanks

  4. #4
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    does the history meet comprehensive?

  5. Default
    EXAMPLE

    If the history is EPF, comprehensive exam, and mod decision making

  6. #6
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    If this isn't the first day then you could use 99232 you only need to meet 2 of the criteria. Otherwise, use 99222.

  7. Default
    It is the first day--admit to hospital. 99222 cannot be used for this because the history does not even meet detailed level.

  8. #8
    Default
    Quote Originally Posted by mgnitecka View Post
    I was wondering if anyone has any information on what to do when an initial hospital visit does not meet the criteria of the 99221? Is it supposed to be downcoded to a subsequent (99231-99233) visit? I can't find any clear documentation on this issue.

    Thanks!
    I read an article in coding edge two years ago ( I know old reference) but after reading this thread I went back thru my old ones...

    It was the Feb 2006 coding edge where they were discussing this very issue, it says " if the hsitory and/or exam are only problem focused or epf the initial hospital care codes cannot be used. If that is the case, the coder must use the unlisted e/m code of 99499 or a subsequent hospital care code; BUT... it is important to check with your individual payers to determine how they want this scenario coded."

    We have had this happen in our practice and we have always contacted the payer to find out how they want it done, in my dealings with this scenario I've been told to code it as a subsequent visit by the carrier.

    Have a good day,
    Last edited by rthames052006; 04-11-2008 at 11:41 AM.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  9. Default Contacting a Payer
    I need to contact a payer to find out what I need to do in this situation, but have never done it before. Who or what department do I need to ask for to get an answer to this question from the carrier?

    Thanks

  10. #10
    Location
    Milwaukee WI
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    Default 99499
    I was just at a Billing/Coding Symposium put on by the Medical Society of Wisconsin. One of the panelists on the E/M presentation was from MediCare. He said they would expect to see 99499 - unlisted E/M if the key components don't equal at least 99221.

    F Tessa Bartels, CPC, CPC-E/M

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