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E/M audit question-When reviewing records

  1. #1
    Question E/M audit question-When reviewing records
    Medical Coding Books
    When reviewing records for an initial hospital visit by the admitting physician and the level of service does not meet the lowest level (99221) what would be appropriate to bill? The records reflect an Expanded Problem Focused HPI, Detailed Exam and Moderate MDM. Would you bill a 99232 or unlisted 99499? I am getting conflicting opinions, some say go with the 99232, others say you shouldn't bill and yet others advise using the unlisted code. These are all Medicare patients which our hospitalists are admitting to the hospital but their documentation in the HPI is not meeting a detailed HPI which is the lowest level initial code.

  2. #2
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    The elements are there for a code level, so I would say the unlisted code does not apply. It would be safer to use the CPT the documentation supports, i.e. 99232.

  3. #3
    Red face
    Quote Originally Posted by buppkl View Post
    When reviewing records for an initial hospital visit by the admitting physician and the level of service does not meet the lowest level (99221) what would be appropriate to bill? The records reflect an Expanded Problem Focused HPI, Detailed Exam and Moderate MDM. Would you bill a 99232 or unlisted 99499? I am getting conflicting opinions, some say go with the 99232, others say you shouldn't bill and yet others advise using the unlisted code. These are all Medicare patients which our hospitalists are admitting to the hospital but their documentation in the HPI is not meeting a detailed HPI which is the lowest level initial code.
    I would advise you to check with this particular carrier and see if they have a medical policy etc.. pertaining to this. In the past I too have heard differant opinions about using a subsequent code vs unlisted, if you do end up sending in the unlisted cpt code, make sure you send a copy of the documentation.
    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"

  4. #4
    Location
    North Carolina
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    Quote Originally Posted by buppkl View Post
    When reviewing records for an initial hospital visit by the admitting physician and the level of service does not meet the lowest level (99221) what would be appropriate to bill? The records reflect an Expanded Problem Focused HPI, Detailed Exam and Moderate MDM. Would you bill a 99232 or unlisted 99499? I am getting conflicting opinions, some say go with the 99232, others say you shouldn't bill and yet others advise using the unlisted code. These are all Medicare patients which our hospitalists are admitting to the hospital but their documentation in the HPI is not meeting a detailed HPI which is the lowest level initial code.
    Palmetto's guideline...


    Can I submit a subsequent hospital CPT code if my documentation does not support one of the three levels of initial hospital services?

    Answer:
    Yes. Submit services that do not meet the minimal documentation requirements for the initial hospital service (CPT codes 99221-99223) as subsequent hospital visits (99231-99233). In all situations, submit the evaluation and management (E/M) code that represents where the visit occurred and that identifies the complexity of the visit performed.


    last updated on 09/23/2011


    http://www.palmettogba.com/palmetto/...pen&navmenu=||

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