tci ED Coding & Reimbursement Alert - 2015 Issue 3

Reader Question: Is It Critical To Have Two Diagnoses To Justify Both 99291 and 99292?

Question: One of our payers is taking back payment for 99291 and 99292 stating their reason is because we only billed one ICD9 code 434.91 (Cerebral artery occlusion, unspecified, with cerebral infarction). Where in the CPT® book can I find information to dispute this reasoning? Original bill included codes 99291, 99292, 31500 (Intubation, endotracheal, emergency procedure), and 93010-59 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) Wisconsin Subscriber Answer: The CPT® book actually says, on page 7 of the 2015 edition, a separate diagnosis for an E/M and a procedure on the same day...

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