When the initial hospital care that you used to bill to Medicare using a consultation code does not add up to the lowest-level inpatient care code, what do you do? This has been the million dollar question since the first day of this year when Medicare stopped accepting consultation codes.
CMS offers a solution for when your neurosurgeon’s initial hospital care does not meet the requirements of 99221.
Payers should overlook initial/subsequent mismatch
According to CMS, even when the provider documents an initial visit, Medicare contractors should not find fault with providers who report a subsequent hospital care CPT code in cases where the medical record appropriately shows that the work and medical record rightly demonstrate that the work and medical necessity requirements are met for reporting a subsequent hospital care code.
Instructing folks to report a CPT code that does not exactly match the service meant that CMS reps were barraged with questions about the topic during an Open Door Forum (ODF).
To avoid 99221 denials by understanding how former consult measures up and to stay tuned to the latest CPT news doing the rounds, sign up for a one-stop medical coding website. When you sign up for one, you can do a free CPT codes online lookup to help you in your code searches. Onboard such a medical coding website, you can also take the help of CPT Assistant to help you with your CPT coding. So go sign up for one today and see how your practice’s revenue looks up.
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