Medical Billing Forum

Coding => Coding => Topic started by: Michele on May 19, 2015, 12:34:22 PM

Title: Observation code 99217
Post by: Michele on May 19, 2015, 12:34:22 PM
Is anyone out there familiar with the appropriate use of 99217?  I am not a certified coder and I have a provider who uses this code 99217 on patients who are inpatient (POS 21).  They are being denied due to the place of service.  I think he is using the code incorrectly but I can't figure out from the CPT book exactly why it is not correct.  The codes 99224-99226 specifically state "at the bedside and on the patient's hospital floor or unit" but 99217 doesn't specify.

Title: Re: Observation code 99217
Post by: PMRNC on May 19, 2015, 01:07:05 PM
Is this a Medicare Patient? Medicare requires the patient be inpatient for a minimum of eight hours before they will consider an observation stay under medical necessity.  99217 really doesn't have too many rules attached to it like no time limits to meet. 

Also you should be using POS 22 if they were admitted under Observation. 99217 really doesn't have too many rules attached to it like no time limits to meet. 
 The visit, like all E&M visits, must be a face-to-face encounter, but there are no time limits you have to meet and no specific crazy rules like most other E/M codes.  You just discharge the patient and bill the CPT 99217 observation discharge code.

Title: Re: Observation code 99217
Post by: Michele on May 20, 2015, 10:14:25 AM
It's actually TRICARE but you gave me some good information.  I do believe he is using it incorrectly.  Thanks for the help!