Medical Billing Forum

Billing => Billing => : mstilger November 02, 2011, 09:10:18 PM

: SNF and E/M codes
: mstilger November 02, 2011, 09:10:18 PM

Hi I am trying to bill a patients HMO replacement plan Pryamid Life which they paid and then came back and recouped payment stating we need to bill the SNF for the E/M code 99213-25 and the wound care 97597. I know the 97597 does go to the SNF and is there responsibilty but for the E/M code when Medicare is involved they are responsible for the E/M code. The HMO is arguing with me that I need to bill the SNF and I cannot find any where on Medicare (WA) site that this is the rule. Can someone please tell me where I can find this!
Thanks
Michele

: Re: SNF and E/M codes
: Michele November 04, 2011, 12:22:07 PM

Is it because they are in the first 100 days of the SNF stay?  The part A portion?  The services may be included in the Part A stay and that is why they are telling you that.  Call them back and ask if that is the case.

: Re: SNF and E/M codes
: billingandscanning November 07, 2011, 04:19:22 PM

I agree with Michelle!