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SNF and E/M codes

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mstilger:
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

Michele:
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.

billingandscanning:
I agree with Michelle!

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