APR 21, 2022
Outpatient Office Visit During Inpatient Stay
We recently had a patient sent to us from our local hospital. We coded the office visit with E/M code 99204 and billed for fundus photos, CPT 92250. Both the office visit and the photos were denied by Medicare, which said the place of service is inconsistent with the procedures submitted. How can we resubmit the claim so that we may be reimbursed?
You should submit the appropriate level of inpatient E/M code and the testing services with place of service -21. From the Fundamentals of Ophthalmic Coding:
“If the patient has inpatient status, however they present to your practice for an exam, submit place of service -21. Also use the inpatient E/M code family 99221-99223 rather than office-based E/M or Eye visit codes. It is best to always submit the exam associated with the place of service to maximize reimbursement. Patients cannot have outpatient services when they have an inpatient status.”
2022 Fundamentals of Ophthalmic Coding (aao.org)