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Otolaryngology Coding Alert

Attention:

Consider Subsequent Hospital Care Instead of Initial Visit Codes

Published on Sat Feb 27, 2010

New CMS guidance attempts solution for removal of inpatient consults. CMS has offered a solution for billing initial hospital care when the service documentation doesn't add up to 99221 -- and the response may add to the confusion. One of the most pressing questions that practices had regarding the elimination of consultation codes was how to bill initial hospital care services that meet the requirements for inpatient consult codes (which are no longer payable), but do not meet the criteria to bill the lowest initial hospital care code, 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 ...). Initially, Medicare administrative contractors (MACs) offered differing advice, with some policies instructing to bill an unlisted E/M code (99499) and others [...]
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