Place of serivce code

Our provider saw an unassigned baby in the emergency room and put the child on observation status. We billed a 99219 for OBS and 99217 for discharge next day. Child has Medicaid they denied our claim stating the 21 POS code was invalid with the ICD9 codes we billed. I sent a corrected claim with 22 POS and claim was still denied for same reason by Medicaid. I am not sure which POS code I should use that will corresponde with the E&M codes we are billing? Help

Karen

everything seems in order

Well, POS 22 is correct. Did you have the correct facility info on your claim?

Your CPT codes seem to be correct too.

What dx code did you use? Although I don't see how that would matter.

Maybe a call to Medicaid is in order...

Place of service code

You may need to change the procedure code. In the state where I am from, Medicaid follows Medicare guidlines. If that is true in the state you are in,the out patient codes to be used would be 99201-99205(new patient) and 99211-99215(established).

Don't you know...

Medicaid follows its own rules, and it changes them whenever it wants, even on a daily basis.

I was denied for an Initial H&P on a patient in hemorrhagic shock from a GI bleed who was admitted to the ICU and died 18 hours later, on a ventilator. Bet you already know the denial "Hospital stay under 24 hours should have been Observation."

This is not correct

[You may need to change the procedure code. In the state where I am from, Medicaid follows Medicare guidlines. If that is true in the state you are in,the out patient codes to be used would be 99201-99205(new patient) and 99211-99215(established).]


With Medicare, those outpatient codes would be used by the Consultants who are asked to see an Observation patient. The attending uses the Observation codes.