Question
Michelle,
I had a question on the 99236 admit/discharge same day. I have been having trouble with this code. Usually I use pos 21 for inpatient but I am finding that some insurance companies deny the claim stating outpatient. Should this be billed as outpatient or inpatient?
Also, I wanted to know if you knew what diagnosis code I could use for intractable headaches.
Thanks
Miriam
Answer
Hi,
I always understood that the place of service was 21 if it went over (the number of hours that makes it an inpatient stay, which I can’t seem to come up with right now!) and if it was under that number of hours, then you would use 22 for outpatient. Also, if you were billing it with the outpatient place of service, then it wouldn’t make much sense to be billing an admit and discharge. I think I would argue this one out with the insurance carrier.
Regarding the headaches, it looks like you add a fifth digit of 1 to the appropriate migraine diagnosis to indicate intractable. See the following chart:
346 Migraine
The following fifth-digit subclassification is for use with category 346:
0 without mention of intractable migraine
1 with intractable migraine, so stated
346.0 Classical migraine
Migraine preceded or accompanied by transient focal neurological phenomena
Migraine with aura
346.1 Common migraine
Atypical migraine
Sick headache
346.2 Variants of migraine
Cluster headache
Histamine cephalgia
Horton's neuralgia
Migraine:
abdominal
basilar
lower half
retinal
Neuralgia:
ciliary
migrainous
346.8 Other forms of migraine
Migraine:
Hemiplegic
ophthalmoplegic
346.9 Migraine, unspecified
Hope that helps,
Michele