Forum - Questions & Answers

Apr 13th, 2015 - vochrisq 3 

Medicare reimbursement

I billed an IP 99222, 99291 w/ 57, and 44120 to medicare.
Medicare payed everything except 99291 w/ 57 stating it is part of the global.

I know that is the correct modifier, but is it not paying bc i have it on the correct CPT®?


Apr 13th, 2015 - petunia 195 

re: Medicare reimbursement

In order to bill both 99291 and 99222 on the same day by the same provider you really have to have good justification in the notes. I typically don't bill both of those together unless they patient admits and later goes critical. In that case you would use the 25 modifier to unbundle 99291 and 99222, but would also need the 57 modifier for the decision for surgery.

Apr 14th, 2015 - vochrisq 3 

re: Medicare reimbursement

I billed 99222 on day1, 99291 on day 2 w/ modifier, and 44120 on day 3.
All consecutive days....would i still use modifier 25?

Thanks so much!

Apr 14th, 2015 - petunia 195 

re: Medicare reimbursement

If you billed 44120 on day 3 and 99222 on day 1, day 1 should not be bundled with that code. I would be sure that the dates are processed correct on the EOB and make sure nothing else was billed on day 1 that could be bundling with 99222 like a minor procedure or something that was done by another provider in your group? We are a large group and find that if we bill something and another provider sees the patient our charges may be included with theirs until we add a modifier.

Apr 14th, 2015 - Codapedia Editor 1,399 

re: Medicare reimbursement

If your documentation shows that the critical care service the day prior to surgery:
met the criteria for critical care
and was the decision for surgery,

Then, I would appeal with notes.

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