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99215 vs 99221

  1. #1
    Default 99215 vs 99221
    Medical Coding Books
    Provider is seeing patient in the hospital prior to surgery. Which visit is correct and are we adding a modifer?

  2. #2
    New Port Richey, Florida
    Default 99215 or 99221
    You did not provide much information but I can tell you that 99215 =
    Office or other outpatient visit for the evaluation and management of an established patient, ....
    would NOT be appropriate if the "provider was seeing the patient IN the Hospital";

    The documention should direct you to the correct code narrative description;

  3. Default more information please
    yes, definitely need more information - different code selection for different places of service.... also would depend on insurance carrier being billed - and reason for visit...was this a pre-op clearance (consultations are no longer paid by Medicare) Also be careful with Global Periods and payment for the day before surgery being captured in the surgery code.

    this was a little vague to be able to give specific info.

  4. #4
    Smile 99212 vs 99221
    This in deed was the pre-op visit, which lead me to believe we should be billing within 99221 to 99223, not the office visit codes of 99212 on.

    We do not bill for any MC patients, its strickly 3 or 4 codes for surgery. However, most of the insurance companies base their fee schedule on MC guidelines. Where do I go to find out if these surgeries have a 24 hour global period prior to surgery?

    Thank You for your help.

  5. #5
    Milwaukee WI
    Default Pre-op
    If the decision for surgery was made at an earlier office visit, the "admit" visit at the hospital is included in the surgery, regardless of whether the procedure is considered major surgery (90-day global) or minor (10-day global).

    If this is the first time the patient is being seen for this condition (e.g. patient arrives in ER and surgeon is called to evaluate), then you can code the appropriate E/M service as per documentation and place of service. Don't forget your modifier if you are performing surgery the same day or the next (-25 modifier for minor procedures; -57 mod for major surgery)

    Hope that helps

    F Tessa Bartels, CPC, CEMC

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