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Thread: Doesn't meet initial inpatient visit?

  1. #1

    Cool Doesn't meet initial inpatient visit?

    AAPC: Back to School
    If the documentation does not meet initial inpatient visit, is it acceptable to bill an established patient visit? My concern is on the WPS website there is an FAQ that states you should use an unlisted code if the documentation does not meet an initial inpatient visit. Thanks, Kim

  2. #2
    Join Date
    Apr 2007
    Phoenix, AZ


    If the documentation does not meet the Initial inpatient visit (99221-99223) levels, yes you can bill a subsequent visit (99231-99233). If the patient is observation or outpatient, yes you bill bill an established Office visit (99212-99215).

    I hope that answers your question.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  3. #3
    Join Date
    Apr 2007


    How do they pay the subsequent visit without initial visit? It is not going to be a issue??

  4. #4
    Join Date
    Apr 2007


    WPS has back off of this position based on MLN SE1010. If they still state otherwise I would email them and advise of the incorrect post on their site.


    Yes, you would use the subsequent care codes if you do not have enough to support the initial.

    Laura, CPC, CPMA, CEMC

  5. #5


    Thank you Laura for the reply!

  6. #6


    Thank you Cyndi for your reply!

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