Wiki E & M Coding

[rbeaver]

I have a situation that I am being told two or three different ways to code.

Patient is In Pt status and doctor dictated a H & P but left out Social History and ROS. I am being told one way to bill this dos is subsequent visit, told that nothing can be billed since physician admitted patient and other way is bill 99499 which is the unlisted code with documentation.

This particular patient has Medicare so I would really like someone to answer this question both ways as if Medicare or other insurance primary.

Also if there is documentation out there to back up decision.

Thanks

RBeaver

 

[mitchellde]

So you have a focused history then whatever else you have for exam and MDM; this is not enough for a 99221 so you do need to code it as a subsequent level, using an unlisted E&M has never worked out for me or anyone else that I have worked with. That does not mean that you cannot use it, but how are you prepared to fight for payment?