# 99231 help



## rich203 (Aug 15, 2013)

Please help - I am new to E/M coding -I have multiple denials with 99231 on multiple days. Any ideas to help with these denials to get paid. Thank you


----------



## mhstrauss (Aug 15, 2013)

rich203 said:


> Please help - I am new to E/M coding -I have multiple denials with 99231 on multiple days. Any ideas to help with these denials to get paid. Thank you



What exactly is the denial?  Are the multiple days all on the same line with multiple units?


----------



## rich203 (Aug 15, 2013)

The denials are for CO4 and CO97 ? These are all on seperate lines with different DOS. Thank you so much for responding. I'm new at E/M and Denials !


----------



## mhstrauss (Aug 15, 2013)

rich203 said:


> The denials are for CO4 and CO97 ? These are all on seperate lines with different DOS. Thank you so much for responding. I'm new at E/M and Denials !



CO4--incorrect modifier, or required modifier missing.

Are the providers MD's? Are there any other services billed on the same DOS for the same provider, or any other provider in the same practice?

CO97--Included in allowed for other procedure

Are these charges in the post-op period for a surgery that was previously performed?
Or on same day as the denied charge?


You're welcome   I definitely remember how frustrating this can be, when you're new and trying to figure everything out!


----------



## rich203 (Aug 15, 2013)

I researched and the providers are MD's - Nothing else billed on the same DOS for the same provider or any other provider in the same practice. Here is what I'm dealing with
Surgery on
06-18   99232 A1 and 57 modifiers added - paid 
06-18   11470 paid
06-19   99231 - not paid
06-20   99231- not paid
06-21   99231- not paid 
06-22   99231- not paid
06-23   99231 - not paid 
06-24   99231- not paid 
any suggestions? Thank you so much!


----------



## mhstrauss (Aug 15, 2013)

rich203 said:


> I researched and the providers are MD's - Nothing else billed on the same DOS for the same provider or any other provider in the same practice. Here is what I'm dealing with
> Surgery on
> 06-18   99232 A1 and 57 modifiers added - paid
> 06-18   11470 paid
> ...



Ahhh, just what I thought. The 11470 performed on 6-18 has a 90-day global period (I'm assuming it was performed by the same MD that has all the denied charges, or maybe the performing MD's partners that are making rounds to cover). So all the follow-up charges in the hospital, along with any office visits for the next 90 days, are not separately billable...unless they are unrelated to the reason for surgery, in which case you should use modifier 24 on the unrelated E/M.

Is the payer Medicare?

Just a side thought...why was an AI used on the 99232 on 6-18? AI is generally used on the initial inpatient visit, which is 99221-99223. Just curious...


----------



## rich203 (Aug 15, 2013)

So, all the follow- up charges in the hospital should be wrote off since this is a global charge? They are related to the reason of surgery. Yes, Medicare. AI was used because as I said I'm new to E/M - error on my part. You have helped me so much today - Thank you. I am the only coder here and I have no one to converse with. I am so glad to be apart of AAPC !


----------



## mhstrauss (Aug 15, 2013)

rich203 said:


> So, all the follow- up charges in the hospital should be wrote off since this is a global charge? They are related to the reason of surgery. Yes, Medicare. AI was used because as I said I'm new to E/M - error on my part. You have helped me so much today - Thank you. I am the only coder here and I have no one to converse with. I am so glad to be apart of AAPC !





As far as writing the denied charges off, that's really up to your practice admin. In my clinic, we don't even post them. Continuously writing them off in similar situations will really inflate numbers, unrealistically. My recommendation is, if you feel like you need to post something, just for tracking purposes, to use either the 99024 (which is what we use for our post-op appts in clinic), or create a dummy code in your PM system specifically for this....maybe use 99024 for clinic E/M, 99999 for Inpatient global visits.

Glad I could help!


----------



## rich203 (Aug 15, 2013)

Thank you for all your help - I will get with the ladies in our insurance office and I'm sure they appreciate all your help also ! 

PS.  If you see my post for any questions in the future I hope you will respond !


----------



## mhstrauss (Aug 15, 2013)

rich203 said:


> Thank you for all your help - I will get with the ladies in our insurance office and I'm sure they appreciate all your help also !
> 
> PS.  If you see my post for any questions in the future I hope you will respond !




You're quite welcome! Good luck with learning the ins and outs of E/M; there are so many gray areas, I still find myself second-guessing much of it. And I'll be happy to respond if I can help.


----------

