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Coder-To-Coder Forum

Started by Schaud3 at 05-28-2010 1:36 PM. Topic has 1 replies.

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   05-28-2010, 1:36 PM
Schaud3 is not online. Last active: 6/8/2011 3:25:23 AM Schaud3

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Joined on 05-28-2010
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Medicare denial
We filed a claim with Medicare using CPT codes 99205 and 90801. Medicare paid only the 90801 because those two codes cannot be billed on the same day same provider. Would we be able to have and immediate offset done on the payment for the 90801 and refile only the 99205?
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   06-04-2010, 3:59 PM
Barb S. is not online. Last active: 1/26/2012 1:47:24 AM Barb S.

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Joined on 12-21-2005
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Re: Medicare denial

If the service provided was a Psychiatric diagnostic interview examination and documentation for the date of service supports that....then 90801 is the most specific code. You would not bill the 99205 New Patient office/outpatient code. As a coder you should code to the most specific code available for the service or procedure.

Not knowing your reason for wanting to switch codes, I offer the following caution: Do not condider billing 99205 rather than the 90801 because reimbursement is better...that could be considered "coding for reimbursement" and that could be considered Fraud. I'm sure that's not your intention.


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