Evaluation and Management (E/M) Services: Hospital Discharge (Procedure Codes 99238-99239)
Top denial/partial denial reasons and high-level results are listed below from each round of JH E/M Services: Hospital Discharge TPE reviews that have been conducted thus far by Novitas. If you have questions about your individual results, please contact the nurse reviewer assigned to your review for additional information. Additional rounds of review will be utilized when the targeted topic demonstrates a continued need for review with newly identified providers.
The most common reasons for denial or partial denials are the following:
Level of care/Incorrect Coding – Documentation submitted for review did not support the level of care billed based on time documented, therefore the claim was changed to reflect the appropriate level of care supported by the documentation and time spent in discharge.
Insufficient Documentation – Insufficient documentation was provided to support the services as billed to Medicare. Novitas Medical Review makes multiple attempts to correct these error types before completion of the review. Below is the following denial reason for insufficient documentation that we were not able to resolve:
No evidence of a face to face visit – Documentation did not support a face to face visit was completed by the rendering provider on the date of service billed.
Round Results
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