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Denials for Initial Hospital Care and Observation E/M Codes: 2024
We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital). Are we doing something wrong?
Question:
We are experiencing denials when we bill 99221-99223 and the place of service is observation (outpatient hospital). Are we doing something wrong?
Answer:
You are billing correctly based on CPT 2023 guidelines for E/M that merged inpatient hospital encounters/codes with observation encounters/codes. Unfortunately, some payor claims processing systems may not yet recognize these changes as they apply to billing. You will have to appeal these denied claims, with CPT references showing the current guidelines for E/M reporting.
*This response is based on the best information available as of 2/29/24.
Coding Laparoscopic Liver Biopsy
Question:
How is a laparoscopic biopsy of the liver reported. Can we use code 47001, Biopsy of liver?
Answer:
47001 Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in addition to code for primary procedure) may only be reported with an open procedure. See CPT Assistant 1992 below. If a laparoscopic biopsy of the liver is performed at the same time as another laparoscopic procedure, for example a laparoscopic cholecystectomy, report an unlisted code (47379). There is no CPT code for a laparoscopic liver biopsy.
*This response is based on the best information available as of 2/1/24.
Cholecystotomy Procedure
How should you code an open cholecystotomy, with a drain placement and a biopsy of the gallbladder wall is performed. Can the biopsy of the gallbladder be separately reported?
Question:
How should you code an open cholecystotomy, with a drain placement and a biopsy of the gallbladder wall is performed. Can the biopsy of the gallbladder be separately reported?
Answer:
No, the biopsy of the gallbladder wall is not separately reportable this is bundled and inclusive to the cholectstotomy. The correct code to report for this procedure would be CPT 47480,Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure).
*This response is based on the best information available as of 12/14/23.
Appendectomy with Cecum Resection
As part of an appendectomy, a portion of the cecum was involved and was included in the resection.. Can this be reported as a cecectomy?
Question:
As part of an appendectomy, a portion of the cecum was involved and was included in the resection.. Can this be reported as a cecectomy?
Answer:
No, that resection is considered part of the appendectomy procedure and not separately reported.
*This response is based on the best information available as of 11/30/23.
POEM Procedure Coding Part 2
I know the POEM procedure, is reported with code 43497,Lower esophageal myotomy, transoral (ie,perioral) endoscopic myotomy (POEM).One of our surgeon does the G-POEM procedure. This is a gastric peroral endoscopic myotomy (G-POEM) how is this reported?
Question:
I know the POEM procedure, is reported with code 43497,Lower esophageal myotomy, transoral (ie,perioral) endoscopic myotomy (POEM).One of our surgeon does the G-POEM procedure. This is a gastric peroral endoscopic myotomy (G-POEM) how is this reported?
Answer:
There is no current CPT code for this procedure. Report with an unlisted code, 43999,Unlisted procedure, stomach.
*This response is based on the best information available as of 11/2/23.
POEM Procedure Coding Part 1
How is the POEM procedure reported?
Question:
How is the POEM procedure reported?
Answer:
The POEM procedure, Peroral Endoscopic Myotomy, had a new code in 2022: 43497,Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy [POEM]). Before January 1, 2022, it was reported using an unlisted code. Although 43497 is an endoscopic procedure, it has a 90-day global period according to CMS.
*This response is based on the best information available as of 10/19/23.
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