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  1. E

    Question Ketamine Therapy and Observation

    Hi, Does anybody know the way to get reimbursed for the mandatory observation after administration of Sprevata or Ketamine infusion for depression or PTSD? I have the website from the manufacturer but that shows to use an E/M Code with a prolonged services code along with the injection (which...
  2. L

    Observation Services

    Per Medicare guidelines, only the ordering physician is allowed to bill observation codes. All other physicians who furnish consults or additional evaluations/services must bill the appropriate outpatient service codes. In our particular case, another physician order observation status. Our...
  3. E

    Medicare Denials - Infusion Coding Guidelines

    Recently, Medicare has denied some infusion, injection, and hydration charges on our observation claims due to not having an initial service billed for each date of service on the claim. Our HIM Dept is stumped because we have always followed the coding guidelines that only 1 initial service...
  4. J

    99225 (observation care)

    Hello, I have a provider who billed a 99225 (subsequent observation care) for the below encounter. Do you believe this is enough to meet for a 99225? Please provide some sort of rationale with you answer if you have enough time. Service: SCIM Date: xx/xx/xxxx...
  5. A


    for consultation done in the E/R- If the physician knows that the patient will be admitted to either the medical floor or as an inpatient, he can use an admission code without the AI modifier correct? what if he gets admitted to observation status? I've read that a new patient (outpatient) code...
  6. M

    Observation Admit - CPT 99218-99220

    Good morning, If there is not enough documentation to support an initial observation admit (99218-99220), would you change this to a subsequent visit (99224-99226) or consult visit (99241-99245)? Thanks, Mary
  7. M

    Observation Codes - Medicaid

    Hello, I am hoping I can get some feedback regarding the coding and billing of Hospital Observation codes for Medicaid patients. According to the HFS Handbook for Practitioners (Observation Section A-220.4) - http://www.hfs.illinois.gov/assets/a200.pdf - "Payment will not be allowed for...
  8. M

    Chemotherapy Physician Charge Clarification

    Hello All. I was hoping someone could help clarify a scenario at my job. I work for an outpatient Cancer Center that is part of a hospital. One of the physician's questioned how the company that handles his professional billing can successfully bill and be reimbursed for observation of the...
  9. M

    Observation to Admit Status for Medicare Patient

    Previously if a patient was admitted for an observation status which turned into an admit status, an office would bill the admit charge as it was the highest level. However, there are some changes with Medicare and the guidelines of observation and 2 midnight stays? Can someone tell me what...
  10. J

    Billing Observation Codes

    My Cardiologist see's patients as observation at the hospital frequently and is not the admitting/attending Dr and he bills 99212-99215. Some insurances state that 99212-99215 is an OV and charges the patients a copay. If I can not bill a new patient code 99201-99205 or a consult 99241-99245...
  11. C

    observation codes for cardiologists

    We are a cardiology practice that is called for services provided in the hospital. I am having quite the issue understanding exactly how to bill observation codes. When our group is consulted to see the patient what code should we be billing if the patient is already admitted to observation...
  12. G

    INPT/OPT admision and discharge same day

    Patient was admitted to the Observation on 1/31/2016. The admitting physician gave the orders over the phone on that day at 5:50pm. He saw the patient the next morning (2/1/2016) and did the H&P. Then, patient was discharged from the Observation on the same day at 4:10pm. How should it be...
  13. C

    Assistant coding out patient / hospital setting E/M code

    Sometimes the providers do the H&P on OB patients who are seen in the labor and delivery floor. However, it states patient are seen as out patient. Do you bill an out patient e/M code or do you bill observation codes? It doesn't mentioned patient is on observation status... I would like to say...
  14. M

    Observation Status

    When a specialist is called in to Consult for a hospital patient kept in Observation status, should I code for OV (99201-99215)? I was denied payment by Novitas (Medicare) for 99220 stating they only pay this code for the admitting doctor and any other physician should code office...
  15. M

    Inpatient vs observation

    I do the insurance appeals for various hospital facilities, I have gotten the following denial several times regarding patients that are originally authorized and admitted as an inpatient but their stay was extended due to continued need for medical treatment. The denial that I will get states...
  16. C

    Out patient hospital coding assistance

    If a patient is seen by the provider as an op in bed, due to vomiting in pregnancy can we bill an e&m visit from the 99212-99214 level... She is getting treated with us for her ob. Im confused as it does not state inpatient or observation status.
  17. M

    Observation versus ER vist and in or outpatient E/M

    We are a private practice specializing in Orthopedic Surgery, with on call duties at the local hospitals. Recently we hired a new coder, who believes our physicians should be using the observation codes when called into ER or when the patient has been admitted by Hospital Medical Services. We...
  18. R

    OBGYN Observation Coding

    Our facility participates on a Residency Program which provides OBGYN teaching. Should an E/M observation code (99217-99220) be billed or E/M outpatient code (99201-99215) when the patient is on Labor and Delivery for 24 hours or less? Thanks.