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General Surgery Coding Alert

You Might Use 'Subsequent' Care -- Even When it's Not

Published on Wed Mar 10, 2010

Absent consult codes, CMS offers this solution for low-level initial care. What should you do when the initial hospital care that you used to bill to Medicare using a consultation code doesn't add up to the lowest-level inpatient care code? That's been the million-dollar question since Jan. 1 when Medicare ceased accepting consultation codes (99241-99255, Office/Inpatient consultation for new or established patient ...). Now CMS offers a solution for when your general surgeon's initial hospital care doesn't meet the requirements of 99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity ...). Payers Should 'Overlook' Initial/Subsequent Mismatch In an MLN Matters article (SE1010), CMS states that even when the provider documents an initial visit, Medicare contractors should "not find [...]
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