Denials for Initial Hospital Care and Observation E/M Codes: 2024

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 3/14/24.

Billing Ultrasound Guidance with Cranial Tumors

Question:

My surgeon uses ultrasound to facilitate locating lesions in the brain and wants to bill 76998-26 for imaging. Is this appropriate? 

Answer:

No, ultrasound to locate a lesion and/or to confirm adequate resection is included in n the primary procedure and not separately billed 

*This response is based on the best information available as of 2/15/24.

Intracranial Cerebral Venogram

Question:

How is an Intracranial cerebral venogram coded?

Answer:

Venous catheterization, with the catheter advanced into the intracanal venous circulation, is reported with code 36012, second order venous catheterization.  The venous imaging is typically a superior sagittal sinus venogram, 75780.

*This response is based on the best information available as of 2/1/24.

Intracranial Endovascular Venous Thrombectomy

Question:

How is an Intracranial endovascular venous thrombectomy coded?

Answer:

There are no intracranial venous endovascular codes, so this must be reported as an unlisted code, 64999.  If performed and documented, a venogram, and the venous catheterization may also be reported.

*This response is based on the best information available as of 12/28/23.

E/M Coding for Emergency Surgery

Question:

Under the revised 2023 EM guidelines what E/M code would be supported for seeing a patient in the the ED for a ruptured cerebral aneurysm and taking them emergently to surgery for repair?

Answer:

This scenario would support , 99223, the highest level of Initial hospital care. Based on:

• High Problem-Acute or chronic illness or injury that poses a threat to life or bodily function and,
• High Risk- Emergency surgery

Remember, only 2 of the 3 medical decision-making elements are needed to support a level of E/M.

*This response is based on the best information available as of 12/14/23.

Kyphoplasty Coding

Question:

How do you report a kyphoplasty at 2 different spine regions, for example at T12 and L1?

Answer:

Use one primary procedure code and an add-on code for additional levels even when crossing spinal regions. Example: T12 and L1 kyphoplasty is reported using 22513 and +22515,not22513 and 22514.

*This response is based on the best information available as of 11/30/23.