Part B Insider (Multispecialty) Coding Alert

Published on Wed Jun 01, 2011 PDF

Question: We saw a patient in the office and then sent her to the hospital for observation. We billed an office visit (99214) and billed observation care (99219) for the same date of service. Our MAC paid both, but now is asking for a refund for the office visit. Should we appeal or send the payment back?

Answer: It sounds as if your MAC is correct. In your situation, you should report only the observation care and not the office visit.

In black and white: Per CPT, "When 'observation status' is initiated in the course of an encounter in another site of service (eg, hospital emergency department, physician's office, nursing facility) all evaluation and management services provided by the supervising physician in conjunction with initiating 'observation status' are considered part of the initial observation care when performed on the same date.... Evaluation and management services on the same date provided in sites that are related to initiating 'observation status' should not be reported separately."