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99219 and 99217

  1. #1
    Murfreesboro, TN
    Default 99219 and 99217
    Medical Coding Books
    Can anyone please give me some advice on billing 99219 and 99217? The ins paid the 99219 but denied the 99217 with the explanation of "This procedure code represents services integral to the more complex primary procedure sumitted on this claim." (meaning the 99219.) Is it a waste of time to also file the discharge code for observation
    (99217) or is there something I need to do to get this paid?

    Thank you,
    Teresa M. Pearce, CPC

  2. #2
    Grand Rapids, MI
    If they are done on the same DOS I would use the 99234 (admit and discharge on same DOS, OBS or Inpatient). If they are done on a seperate DOS both should be payable. If a procedure was also done on the same DOS I would use the 25 modifer on your e/m if the documentation supports it.

  3. #3
    Murfreesboro, TN
    Thank you for your response. The admit was on 08/31 and the dc on 09/01. Is there any supporting documentation I need to submit with the claim? Maybe a facesheet from the hospital?


  4. #4
    Grand Rapids, MI
    I would double check with the hospital billing/prior auth. area. I have had it where they actually stayed another day or went home early. Otherwise I would send the discharge dictation in to support that code billed.

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