CPT^® 99255, Under New or Established Patient

The Current Procedural Terminology (CPT^®) code 99255 as maintained by American Medical Association, is a medical procedural code under the range - New or Established Patient.

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Summary

The provider sees a patient for an inpatient or observation consultation involving evaluation and management (E/M). The E/M involves a high level of medical decision making or the provider spends at least 80 minutes of total time on the encounter on a single date.

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CPT codes for inpatient substance abuse MAT treatment, mostly with suboxone and subutex.

Hi Taliafate Ensure document properly, listing medication prescribed given, and dx range from F11 to F14 F16 F17 linking with description of care given. Medicare coverage is lsited as such...there are... [ Read More ]

Insurance Denial

In March 2022 I went to the ER because I thought I had a blood clot in my thigh. I did and I also had a pulmonary embolism. I was kept overnight in Observation and for a second night. I was admitt... [ Read More ]

NP Hospital Billing for Consult Visit

[QUOTE="lgarcia96, post: 512130, member: 663018"] I added the initial admit code (99222) - we are aware we have to bill this in place of the consult code range (99251-99255). In our office we still ca... [ Read More ]

NP Hospital Billing for Consult Visit

[QUOTE="Orthocoderpgu, post: 512129, member: 29238"] Are you sure you are using the correct code set? Most insurance companies no longer consider consult codes for benefits any longer. Just because yo... [ Read More ]

Modifier 25 with 99223 and 99497

Based on NCCI guidelines, modifier 25 would be appended to CPT 99497 when reported with 99223 when appropriate. For this NCCI edit pair, CPT 99223 is the column 1 code and 99497 is the column 2 code.... [ Read More ]

inpatient coding

At least for the last few years, CPT guidelines state "For initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subs... [ Read More ]

AETNA CONSULTS

CPT guidelines for at least the last couple of years state "For initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or... [ Read More ]

Denials with 99222/99223

[QUOTE="amyjph, post: 505371, member: 172045"] This could be a few different things. 1. Is the provider you are billing for the admitting physician of record? 2. If so, is the payer looking for the AI... [ Read More ]

Denials with 99222/99223

This could be a few different things. 1. Is the provider you are billing for the admitting physician of record? 2. If so, is the payer looking for the AI modifier? 3. Is the patient definitely IP and... [ Read More ]

AETNA DENIALS MAINLY WITH W BEGINNING OF ID#

My guess is that they still use Consultation codes 99241-99245 99251-99255. There aren't many payers out there that do, but the fact that they are saying they only allow one "initial" visit per day l... [ Read More ]

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