The physician I work for admits patient's to observation on a regular basis. I have a situation with Medicare where a patient was admitted to obsveration on 2/25 (99219), had a 2nd day in observation on 2/26 (99218) then admitted as an inpatient on 2/27 (99222) and stayed an inpatient until 3/1. All was paid except for the 99218, 2nd day in observation. The denial code was C0-151, payment adjusted b/c the payer deems the info submitted does not support this many/frequency of services. We appealed the claim and sent medical records. They've denied our appeal for the same reason.
I've pulled an EOB where they paid for the 99218 in the exact same situation. We bill this way all the time and it's paid all the time, except this one.
We are sending medical records again, along with the copy of the EOB where they paid in a previous situation.
anyone familiar or knowledgable regarding these codes and limitations? I am having a hard time finding any info on it on the Medicare website.
thanks
I've pulled an EOB where they paid for the 99218 in the exact same situation. We bill this way all the time and it's paid all the time, except this one.
We are sending medical records again, along with the copy of the EOB where they paid in a previous situation.
anyone familiar or knowledgable regarding these codes and limitations? I am having a hard time finding any info on it on the Medicare website.
thanks