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PA Medicaid Admission Denial

Kelly Posted Wed 09th of November, 2011 18:34:17 PM

Our physician saw a patient in the hospital with PA Medical Assistance and coded a few 99232 visits and also a 99238 discharge. The stay was denied by medical assistance per the hospital. We have no authorization to bill along with the codes which will result in denial. Can we bill anything for these days (such as OP office visit 99211-99215) or are they a complete loss?

SuperCoder Answered Thu 10th of November, 2011 02:56:14 AM

Are you all the hospital stay codes like 99232 and also the Discharge code 99238 denied ??? or is it only 99238?

Kelly Posted Thu 10th of November, 2011 19:28:42 PM

I haven't billed the services yet. The hospital's utilization department that obtains authorizations for admissions told me that the admission itself was denied. Therefore there is no authorization code to bill along with the services. All codes will be denied asap if we enter it into the PA Medicaid claims system. That is always what happens if we enter Inpatient E&M services without a authorization code. Are we allowed to bill any OP E&M codes in their place??

SuperCoder Answered Thu 10th of November, 2011 20:00:19 PM

As you said, Inpatient E&M services of yours are getting denied without a authorization, you can educate both patients and physicians as it is a routine process of obtaining prior autorization essential for a patient to be admitted to the hospital.

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