Ok, this doesn't happen often but it does happen. Medicare has advised us when an E/M service is provided but the documentation does not support the code you use an unlisted code.
So for an admit, you only have an EPF history, the lowest level 99221 requires detailed. Per Medicare we would use 99499 and send notes. Ok, this works they pay.
Medicaid, is turning into a different story. I have spent an hour on the phone today and I am currenlty waiting for a call back.
Medicaid doesn't pay for unlisted codes without an auth, or so they told me today. They have batted me back and forth between 3 different departments so far. So my question to them is would the appropriate way to handle this be with the unlisted or would we use the defined code with a 52 modifier.
Does anyone have any type of guidance from medicaid on this situation?
Thanks
Laura, CPC, CEMC
So for an admit, you only have an EPF history, the lowest level 99221 requires detailed. Per Medicare we would use 99499 and send notes. Ok, this works they pay.
Medicaid, is turning into a different story. I have spent an hour on the phone today and I am currenlty waiting for a call back.
Medicaid doesn't pay for unlisted codes without an auth, or so they told me today. They have batted me back and forth between 3 different departments so far. So my question to them is would the appropriate way to handle this be with the unlisted or would we use the defined code with a 52 modifier.
Does anyone have any type of guidance from medicaid on this situation?
Thanks
Laura, CPC, CEMC