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Modifiers on 99231

Meredith Posted Mon 28th of October, 2013 11:34:44 AM

We have billed subsequent and non subsequent hospital follow up days using code "99231" ever since i have been coding here; recently we have been getting rejections from Medicare and Medicaid stating they need a modifier to pay for this. No other procedure was done that day, so I am stumped. What modifiers could they be asking for?

SuperCoder Answered Mon 28th of October, 2013 16:20:19 PM

Check to see if the procedure or surgery has a 90 day global period. If so, all follow up charges in the hospital, along with any office visits for the next 90 days are not separately billable...unless they are unrelated to the reason for surgery, in which case you should use modifier -24 on the unrelated E/M.

Meredith Posted Mon 28th of October, 2013 17:33:58 PM

There was no procedure or surgery performed, just 3-5 days in the hospital for different reasons.

SuperCoder Answered Tue 29th of October, 2013 12:56:23 PM

At this point you will have to call the Medicare/Medicaid providers who are denying these claims and ask them to specifically tell you what they are looking for. Place the burden on them to explain how they want you to code subsequent hospital care.

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