Avoid Denials With Proper Billing For 99293

Avoid Denials With Proper Medical Billing For 99293

There are many medical billing codes that were created specifically for pediatrics. However, there are other areas of medical billing that do not have these specific codes for children. This makes coding very difficult and inconsistent. Many people wonder if the CPT code 99293 should be billed for an outpatient emergency room exam for a baby instead of using code 99291.

The medical billing code 99291 means critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes. You would use this code if a patient came into the emergency room and was there for a half and hour up to 74 minutes. This is pretty straight forward in medical billing. The confusion comes in when using code 99293. This means Initial inpatient pediatric care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age. This code should only be used if the infant is admitted inpatient.

When doing medical billing it becomes confusing because there is no code specifically for outpatient emergency room visits for children. There is only a child specific medical billing code for inpatient visits. A simple rule of thumb in medical billing is that the location of service MUST match the CPT code. This is because inpatient evaluations get reimbursed at different levels then outpatient emergency room visits.

There are many rules and regulations when it comes to current procedural terminology codes. As you can see, thorough education is needed in order to be a successful medical biller. To transfer the in-depth training responsibilities from your practice to someone else, you should contact an outside medical billing firm. These firms can help you with all of your medical billing needs

View all Articles by: Melissa Clark, CCS-P