Otolaryngology Coding Alert

Question: Another doctor asked my ENT for a consult with a patient who had been admitted for an observation stay. Should I use 99218-99220?


New Hampshire Subscriber
Answer: Because your ENT is involved with the patient in a consult-ative capacity, you should report his services with the appropriate outpatient consultation code (99241-99245). But if your doctor admits the patient to the hospital, you should more accurately report his service with the applicable initial inpatient care code (99221-99223.).

Only one physician can bill the observation admit codes (99218-99220, Initial observation care, per day ...) per observation stay. Because observation is an outpatient setting, all other physicians treating the patient in observation should report outpatient care codes

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.