tci General Surgery Coding Alert - 2004 Issue 3

Reader Question: Report 99255 Just Once Daily

Question: If I report 99255 more than once for the same patient on different days, Medicare does not pay, stating that this is a "duplicate procedure." Is my carrier processing the claim correctly?Oregon Subscriber Answer: The descriptor for 99255 (Initial inpatient consultation for a new or established patient ...) clearly indicates "initial" inpatient consultation, and CPT further says, "Only one initial consultation should be reported by a consultant per admission." In other words, Medicare is correct in this case. If your physician sees the same patient several times during a single hospital stay, you may...

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