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Confused about specialist billing for Observation patients

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keashdoc:
Hi,

I am really confused about how specialists are supposed to bill for Medicare Observation?   I was using the observation codes (99218 -99220) for the initial specialist consultation visit and (99224 to 99226) for the subsequent consultation followup visits.  However, the payments are a hit or miss so I am assuming I am doing something wrong.   As a CONSULTANT am I supposed to bill the clinic visit codes (99201 - 99205) for the initial observation visit and (99211 to 99215) for the subsequent followup visits with a POS of 22?    Any help would be truly appreciated.     

K

Michele:
You would not bill 99201-99215 with a POS of 22.  The purpose of the Observation codes 99218-99220 is to determine if the patient needs to be admitted, or if they can be discharged.  I don't believe they are to be used to replace the consultation codes that are no longer covered.  From my understanding specialists are supposed to use 99231-99233 inpatient visit codes. 

keashdoc:
I appreciate the reply but we actually cannot bill the inpatient codes because those get automatically rejected as patient is observation status.  We can't bill 99218 to 99220 as those are for admitting MDs only and not for consultants. 

Michele:
Interesting issue.  You can't use the 99201-99215 either as those are for POS 11.  Have you tried looking at modifier 77?   It's not perfect, and you most likely will have to appeal with documentation but it may work.

 

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