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99254 vs 99285

Janet Posted Wed 11th of July, 2012 21:35:41 PM

Pt came through ER 6/15 @ 12:51pm and admitted on same day @ 4:40pm. My dr didn't see pt until 6/15 @ 10:47pm. I billed 99254 POS inpatient. I'm being told it should be 99285 because pt came through ER even though my dr didn't see pt in ER. Pt had limited Medi-Cal coverage where only ER/pregnancy related services covered. Which is correct??

SuperCoder Answered Thu 12th of July, 2012 06:14:06 AM

I would prefer to code 99254 with inpatient POS because patient got admitted on the same day. Even though patient came through ER, but lastly patient is admitted. Therefore E/M visits won't qualify for this scenario. As per CPT manual, it states that if the patient is admitted after outpatient consultation (eg. office, ED etc.) and the patient is not seen on the unit on the date of admission, report only outpatient consult codes (99241-99245). If the patient is seen by the consultation on the unit on the date of admission, report all the consult related to the admission with either inpatient consult code (99251-99255) or with initial inpatient admission service code (99221-99223).

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