Wiki 2009 Observation Hospital Rounding Code


Mcminnville, OR
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For a Hospitalist in 2009, a patient admitted on observation 99220 then rounded on the next day, on a 99215 is that correct? Medicaid told us if we had seen the patient in the last three years we had to use an established patient CPT code. This code is now under scrutiny and am wondering if some payers would have accepted the 99204 series?

January 2011 the observation rounding codes changed over to the 99226 series and I am thinking the payer is just not saavy on Hospitalist services OR did we actually use the wrong code?

A lotta help please!
The 9921x series is correct for 2009. Your code may be under scrutiny because of the level used (99215). Many states are doing medicaid audits expecially of comprehnsive codes. You may want to check the note to make sure is meets documentation guidelines for a level 5 visit and if not take correcgive action.
2009 Observation rounding code

Thank you dclark7 for your rapid response. I was sure i was right but the more I got challenged the more I began to doubt what I knew I KNEW!!

I did audit the notes and for those that don't meet criteria we are submitting a redetermination.

Again thank you so very much.