nyyankees
True Blue
We have a Medicare patient with 99252. Since Medicare no longer recognizes consults we need to change code. But 99221 requirements are more indepth than 99252. How would you code? I've been told to use 99231-99233 series. Thanks.
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Wiki Downgrading E/M
- Thread starter nyyankees
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MnTwins29
True Blue
Since the initial hospital inpatient codes 99221-99223 require at least a detailed history and exam, CMS has stated that if these key elements do not meet that level, then the 99231-99233 codes should be used. Therefore, to answer your question, I would evaluate the three key elements and if the history and exam do not meet initial inpatient visit criteria, then use theme to determine the proper subsequent hospital visit (99231-99233) code.
RebeccaWoodward*
True Blue
In case you need the MLN Matters article...
Q. How should providers bill for services that could be described by CPT inpatient consultation codes 99251 or 99252, the lowest two of five levels of the inpatient consultation CPT codes, when the minimum key component work and/or medical necessity requirements for the initial hospital care codes 99221 through 99223 are not met?
A. There is not an exact match of the code descriptors of the low level inpatient consultation CPT codes to those of the initial hospital care CPT codes. For example, one element of inpatient consultation CPT codes 99251 and 99252, respectively, requires “a problem focused history” and “an expanded problem focused history.” In contrast, initial hospital care CPT code 99221 requires “a detailed or comprehensive history.” Providers should consider the following two points in reporting these services. First, CMS reminds providers that CPT code 99221 may be reported for an E/M service if the requirements for billing that code, which are greater than CPT consultation codes 99251 and 99252, are met by the service furnished to the patient. Second, CMS notes that subsequent hospital care CPT codes 99231 and 99232, respectively, require “a problem focused interval history” and “an expanded problem focused interval history” and could potentially meet the component work and medical necessity requirements to be reported for an E/M service that could be described by CPT consultation code 99251 or 99252.
http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/se1010.pdf
Q. How should providers bill for services that could be described by CPT inpatient consultation codes 99251 or 99252, the lowest two of five levels of the inpatient consultation CPT codes, when the minimum key component work and/or medical necessity requirements for the initial hospital care codes 99221 through 99223 are not met?
A. There is not an exact match of the code descriptors of the low level inpatient consultation CPT codes to those of the initial hospital care CPT codes. For example, one element of inpatient consultation CPT codes 99251 and 99252, respectively, requires “a problem focused history” and “an expanded problem focused history.” In contrast, initial hospital care CPT code 99221 requires “a detailed or comprehensive history.” Providers should consider the following two points in reporting these services. First, CMS reminds providers that CPT code 99221 may be reported for an E/M service if the requirements for billing that code, which are greater than CPT consultation codes 99251 and 99252, are met by the service furnished to the patient. Second, CMS notes that subsequent hospital care CPT codes 99231 and 99232, respectively, require “a problem focused interval history” and “an expanded problem focused interval history” and could potentially meet the component work and medical necessity requirements to be reported for an E/M service that could be described by CPT consultation code 99251 or 99252.
http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/se1010.pdf
MnTwins29
True Blue
Thanks Rebecca - I was searching for that MLM after posting the answer - guess you can navigate the CMS site faster than I can!
deedeemaguire
Contributor
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E/M Help
I am interested in taking my E/M exam again but I get confused with the selection of MDM. I have noticed different views on the # of points for the dx or treatment options & amount of data reviewed. Also, determining between expanded problem focused vs detailed exam. Can someone please help me with this and if anyone has any suggestions on how to understand this
I want to feel confident in taking the exam and I noticed the notes are quite long and you only have a certain amount of time to read them and answer the questions. My problem is I am thorough and I know I need to be fast. Can someone help me.
Thank you so much for your help
I am interested in taking my E/M exam again but I get confused with the selection of MDM. I have noticed different views on the # of points for the dx or treatment options & amount of data reviewed. Also, determining between expanded problem focused vs detailed exam. Can someone please help me with this and if anyone has any suggestions on how to understand this
I want to feel confident in taking the exam and I noticed the notes are quite long and you only have a certain amount of time to read them and answer the questions. My problem is I am thorough and I know I need to be fast. Can someone help me. Thank you so much for your help