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"99222"

Paula Posted Tue 21st of July, 2015 16:44:40 PM

My question is: If our Doctor originally billed 99222 (initial hospital care) in May, and in June, patient returned to the hospital due to amputation infections, can he bill another 99222 and does it need a modifier.
Seconding billing is 99222 57 dos 6-10-15
11012 58 dos 6-11-15
97605 59 dos 6-14-15
11012 58 dos 6-14-15
97605 59 dos 6-14-15

Thanks,
Center for Orthopaedic Surgery & Sports Medicine

SuperCoder Answered Wed 22nd of July, 2015 01:26:20 AM

Yes, Doctor can bill the another Initial Hospital care E/M code (99222) for June visit. Modifier -57 should be used if decision for surgery has been made during the E/M service.

Paula Posted Wed 22nd of July, 2015 11:20:20 AM

That's exactly what we did and Medicare denied 99222 57
and paid 11012 58, 97605 59, 11012 58, 97605 59.
are we billing the correct code??

Thank You,

Center For Orthopaedic Surgery & Sports Medicine

SuperCoder Answered Thu 23rd of July, 2015 00:59:26 AM

The surgery your doctor did on 6-11-15 and 6-14-15 do not have 90 day global period. May be this is the reason of CPT 99222 denial, because you are billing it with -57 modifier, which should be used, if decision of major surgery has been made on the day of surgery or on 1 day prior to major surgery. Your doctor did not do any major surgery having global period of 90 days. Try to bill CPT 99222 without -57 modifier.

Paula Posted Thu 23rd of July, 2015 15:18:25 PM

IF THE PATIENT HAD AN INITIAL HOSPITAL CARE IN MAY 99222 57, HAD SURGERY THE NEXT DAY, WAS THEN READMITTED IN JUNE FOR AN INFECTION PERTAINING TO THE FIRST SURGERY, CAN I BILL 99222 24 OR IS THIS INCORRECT BILLING

THANKS,
CENTER FOR ORTHOPAEDIC SURGERY & SPORTS MEDICINE

SuperCoder Answered Fri 24th of July, 2015 01:03:04 AM

Yes, you can bill it as 99222 -24 modifier. But do check your level of E/M care.

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