99222 code

I just came thru a denial from Coventry where they have denied to pay a claim billed with CPT® 99222 and POS 21. How can I get the payment?

re: 99222 code

What is the denial reason?

re: 99222 code

They says 99222 can not be billed with 21 pos and I need to correct the code and send a CORRECTED CLAIM along with the Medical Records.

re: 99222 code

Are you sure the patient was admitted (inpatient)? If the facility sent their claim with obs (outpatient) POS or ER, it can mess up your claim.

re: 99222 code

21 Inpatient Hospital
A facility, other than psychiatric, which primarily provides diagnostic,
therapeutic (both surgical and nonsurgical), and rehabilitation services by,
or under, the supervision of physicians to patients admitted for a variety of
medical conditions.

re: 99222 code

First you need to confirm with Hospital/Facilty that how did they treated patient as inpatient or outpatient. If they treated or billed the patient in Observation then you would have to change your coding accordingly with POS 23 and you would have to chose code one of the following:
99218
99219
99220
and if they bill patient as in patient then you would need to call insurance and ask them to reprocess claim as it is invalid denial and 99222 with 21 is appropriate. you need to convince insurance CSR to reprocess your claim.
These kind of denials might be due to confliction between facility and provider billing confliction like hospital is biling out patient and provider is billing in patient and vice versa.

re: 99222 code

First you need to confirm with Hospital/Facilty that how did they treated patient as inpatient or outpatient. If they treated or billed the patient in Observation then you would have to change your coding accordingly with POS 23 and you would have to chose code one of the following:
99218
99219
99220
and if they bill patient as in patient then you would need to call insurance and ask them to reprocess claim as it is invalid denial and 99222 with 21 is appropriate. you need to convince insurance CSR to reprocess your claim.
These kind of denials might be due to confliction between facility and provider billing confliction like hospital is biling out patient and provider is billing in patient and vice versa.

re: 99222 code

I am billing for the Medical part of a Mental Health patient. The Facility is a Psychiatric hospital.

re: 99222 code

Would POS code 51 or 52 work for you?

51 Inpatient Psychiatric Facility A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician.

52- Psychiatric Facility Partial Hospitalization A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility.