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Inpatient consult

  1. #1
    Default Inpatient consult
    Medical Coding Books
    Can my fellow ortho coders help me out here -

    My doc did consult on inpatient - he did not meet documentation for 99221 .....it was my understanding from medicare that if doc does not meet 99221 then you should use inpatient follow up codes 99232. They denied me saying it is included in global.....I am assuming because I used a follow up code - even though I did put 24 on it.

    It was completely different body part/injury, hence the 24

    Is anyone else having this issue? Am I misunderstanding the use of the consult codes?

  2. Default
    GREAT question. My understanding is that only the admitting doc can charge 99222. Consultants have to use the 99232 with no modifiers for in patients even though this is the first time they have seen the patient. Why are they denying as "global" ??? Can't wait to see the answer to this.

  3. #3
    Location
    Greenville SC
    Posts
    49
    Default
    Is this a Medicare patient? If so then your consult for an inpatient would be the 99221-99223...the Admitting Doc uses the same code but adds the AI modifier was my understanding.

  4. #4
    Location
    Greater Pittsburgh
    Posts
    390
    Default
    Yes, I agree with bmeech, if the patient is a Medicare pt (or Medicare product) the correct codes are 99221-99223 for a consult with appropriate modifers if needed (24,25,57, etc)...the attending/admitting Dr. uses the same BUT with the AI (admitting inpatient) modifier .
    jdemar, CPC, CMA

  5. #5
    Location
    Greenville SC
    Posts
    49
    Default
    To answer your question of not enough documentation to support the 99221-99223 these codes we have been told to use 99231-99233 based on documentation. Which does not really make much since to me if this is your first visit with the patient

  6. #6
    Default answer
    Quote Originally Posted by PLAIDMAN View Post
    Can my fellow ortho coders help me out here -

    My doc did consult on inpatient - he did not meet documentation for 99221 .....it was my understanding from medicare that if doc does not meet 99221 then you should use inpatient follow up codes 99232. They denied me saying it is included in global.....I am assuming because I used a follow up code - even though I did put 24 on it.

    It was completely different body part/injury, hence the 24

    Is anyone else having this issue? Am I misunderstanding the use of the consult codes?
    We did speak to medicare rep; my thoughts were correct regarding the use of subsequent care codes (99232 ect...) in place of intial inpt. care codes (99221) when the documentation does not meet requirements of 99221, cited MLN matters article SE1010 which states "cms has instructed medicare contractors to not find fault with providers who report subsequent hospital care cpt code (when documentation is met for 99232 ect....) even though the reported code is for the providers first E/M service"

    She stated it was a dx issue not a cpt code issue (long, stinky anwers) so we are resubmit with documentation and the claim will be reviewed.

  7. #7
    Location
    Greenville SC
    Posts
    49
    Default
    Thanks!!! that is exactly what I was looking for..."

  8. Question Question??
    QUOTE=bmeech;177391]Thanks!!! that is exactly what I was looking for..."[/QUOTE]

    Hello,

    I went to that link and I did not find that information, would you kindly point out where in the article it says that. Also who is your Medicare carrier?

    http://www.cms.gov/MLNMattersArticle...ads/MM6740.pdf

    Thanks for your help!


  9. Talking Thank you!
    Quote Originally Posted by maryanneheath View Post
    Hi MaryAnne,

    Thank you, I found it! It amazes me how Medicare explains it in such an ambiguous away instead of just saying bill for a subsequent visit anything less than a 99221, based on a expanded problem focused history or less... just my opinion..

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