tci E/M Coding Alert - 2014 Issue 12

Reader Question: Identify Patient as Established for 99231-99233

Question: On a recent claim, I used a CPT® code for subsequent hospital care to report my physician’s first E/M service with a new patient during their hospital stay. Will the claim be denied? Massachusetts Subscriber Answer: Keep in mind that the “new patient” concept does not apply in the hospital setting. If the physician was asked to consult on a patient with Medicare (or a payer that follows Medicare guidelines) and his documentation doesn’t support at least a 99253 (Inpatient consultation for a new or established patient, which requires these 3 key components: a detailed...

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