1. P

    Wiki Can an NP or a PA bill Observation Codes for Medicare Patients?

    Hello, Can an NP ( Nurse Practitioner ) or a PA ( Physician Assistant ) bill for Hospital Observation Codes 99234-99236 for Medicare Patients? Is this allowed and paid by Medicare? Thank you.
  2. R

    Wiki How do you bill postoperative observation/recovery room?

    I have a UHC claim denial for revenue code 0710 for missing the associated CPT/HCPCS code. I assumed revenue code didn't require a CPT code. The patient underwent a septoplasty and was admitted to observation overnight, for which revenue code 0710 was billed without a CPT code. I was thinking to...
  3. jkyles

    Wiki 2023 E/M guidelines

    The guidelines that will go into effect 1/1/2023 are available. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf Enjoy! :geek:
  4. J

    Wiki Extended ER

    I have a scenario that I have never come across before so I want to get some input. Patient presents to ER on 1/6 for chest pain. Cardiac protocol followed. Patient was planned to be transferred out for higher level of care but no beds were available at any of the hospitals in the state. The...
  5. M

    Wiki Observation Codes and POS 21

    Hello, can observation codes be billed under POS 21?
  6. E

    Wiki 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...
  7. L

    Wiki 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...
  8. E

    Wiki 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...
  9. J

    Wiki 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...
  10. A

    Wiki consultation

    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...
  11. M

    Wiki 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
  12. M

    Wiki 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...
  13. M

    Wiki 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...
  14. M

    Wiki 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...
  15. J

    Wiki 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...
  16. C

    Wiki 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...
  17. G

    Wiki 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...
  18. C

    Wiki 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...
  19. M

    Wiki 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...
  20. M

    Wiki 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...
  21. C

    Wiki 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.
  22. M

    Wiki 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...
  23. R

    Wiki 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.