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PLAIDMAN

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Can my fellow ortho coders help me out here -

My doc did consult on inpatient - he did not meet documentation for 99221 .....it was my understanding from medicare that if doc does not meet 99221 then you should use inpatient follow up codes 99232. They denied me saying it is included in global.....I am assuming because I used a follow up code - even though I did put 24 on it.

It was completely different body part/injury, hence the 24

Is anyone else having this issue? Am I misunderstanding the use of the consult codes?
 
GREAT question. My understanding is that only the admitting doc can charge 99222. Consultants have to use the 99232 with no modifiers for in patients even though this is the first time they have seen the patient. Why are they denying as "global" ??? Can't wait to see the answer to this.
 
Is this a Medicare patient? If so then your consult for an inpatient would be the 99221-99223...the Admitting Doc uses the same code but adds the AI modifier was my understanding.
 
Yes, I agree with bmeech, if the patient is a Medicare pt (or Medicare product) the correct codes are 99221-99223 for a consult with appropriate modifers if needed (24,25,57, etc)...the attending/admitting Dr. uses the same BUT with the AI (admitting inpatient) modifier .
 
To answer your question of not enough documentation to support the 99221-99223 these codes we have been told to use 99231-99233 based on documentation. Which does not really make much since to me if this is your first visit with the patient
 
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PLAIDMAN said:
Can my fellow ortho coders help me out here -

My doc did consult on inpatient - he did not meet documentation for 99221 .....it was my understanding from medicare that if doc does not meet 99221 then you should use inpatient follow up codes 99232. They denied me saying it is included in global.....I am assuming because I used a follow up code - even though I did put 24 on it.

It was completely different body part/injury, hence the 24

Is anyone else having this issue? Am I misunderstanding the use of the consult codes?
Click to expand...

We did speak to medicare rep; my thoughts were correct regarding the use of subsequent care codes (99232 ect...) in place of intial inpt. care codes (99221) when the documentation does not meet requirements of 99221, cited MLN matters article SE1010 which states "cms has instructed medicare contractors to not find fault with providers who report subsequent hospital care cpt code (when documentation is met for 99232 ect....) even though the reported code is for the providers first E/M service"

She stated it was a dx issue not a cpt code issue (long, stinky anwers) so we are resubmit with documentation and the claim will be reviewed.
 
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