Wiki 2021 E/M Changes

[sdiehl]

I have recently watched the workshop for the 2021 E/M changes. I understand the code sets involved will be 99202-99215. The question has come up regarding the place of service. I understand the observation codes do not apply but what about patient's in an observation status at a hospital that the providers would use this code set? An example is a consulting physicians in an observation stay at a hospital. Is this place of service driven or is it all CPT code driven? This will help determine our education plan going forward.

 

[bdcoyne8]

I do not believe the guidelines have changed in that aspect.

The provider who ADMITS the patient into observation is the only one who can bill the observation codes. Guidelines instruct us that if the consulting physician IS NOT the one who admitted the patient into obs, we must bill for the E/M services 99201-99215. I do not think they will change those guidelines as that is why we have obs codes and E/M codes. POS should not matter in this instance. If your physicians are typically consulting to a patient who is already admitted, they would use the 99202-99215.