Blackhorse
Guru
We have received the denial and was told that on the DOS, PT was in the hospital. Our doctor did call and talked to the PT on that day. Can we bill 99442 with POS 11.
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Wiki 99213 POS 11 MOD 95 is denied by Medicare
- Thread starter Blackhorse
- Start date
lexvcarter
Guest
Here is the definition for code 99442. Did the claim meet the requirements? Also, POS varies depending on if it's inpatient or outpatient.
"An established patient calls the provider with a new complaint. The call cannot be related to an E/M that occurred within the last seven days and cannot trigger an appointment within 24 hours or at the earliest available time. In an 11 to 20 minute call, the provider gets a brief history from the patient, reviews the patient’s current list of medications, and makes a medical decision regarding recommended treatment, with a note to call if symptoms don’t improve. The provider documents the specifics and the amount of time for the discussion in the patient’s chart. Discussion with other providers is included in the code."
"An established patient calls the provider with a new complaint. The call cannot be related to an E/M that occurred within the last seven days and cannot trigger an appointment within 24 hours or at the earliest available time. In an 11 to 20 minute call, the provider gets a brief history from the patient, reviews the patient’s current list of medications, and makes a medical decision regarding recommended treatment, with a note to call if symptoms don’t improve. The provider documents the specifics and the amount of time for the discussion in the patient’s chart. Discussion with other providers is included in the code."
Blackhorse
Guru
What's the safest E/M code to use if the doctor called inpatient patient?
lexvcarter
Guest
Hm no no.. Coding isn't based on "safety." You'll need to find out if the hospital was inpatient or outpatient. I have provided ample amount of info for ya. 
- https://www.aapc.com/blog/50156-telehealth-faq-you-asked-we-answered/
- https://codingintel.com/payment-for-phone-calls-cms-update/
SharonCollachi
Guest
The OP stated the doctor called the patient, not the other way around.Hm no no.. Coding isn't based on "safety." You'll need to find out if the hospital was inpatient or outpatient. I have provided ample amount of info for ya.
"An established patient calls the provider with a new complaint. The call cannot be related to an E/M that occurred within the last seven days and cannot trigger an appointment within 24 hours or at the earliest available time..."
- https://www.aapc.com/blog/50156-telehealth-faq-you-asked-we-answered/
- https://codingintel.com/payment-for-phone-calls-cms-update/
lexvcarter
Guest
I don't think that would matter. Correct me if I'm wrong though.
SharonCollachi
Guest
You're giving the definition of the code the OP asked about, which is for a patient-initiated phone call. But it wasn't a patient-initiated phone call.
If it's telehealth due to covid, then there are ways to bill that interaction.
If it's telehealth due to covid, then there are ways to bill that interaction.
lexvcarter
Guest
In the original post they mentioned if they could use 99442. Provided the definition thinking they would read it, correct their mishap & we could collaborate from there.