2023 observation cpt codes

[shelleywinters2008@yahoo.com]

With the new changes in the deletion of the observation cpt codes, should we be keeping the place of service as 22? I ask because we have a stand alone observation unit and I read that if that was the case we could use the obs cpt codes. Just need help with clarification.

 

[rachaelwilleford]

Yes, the CPT code definitions have been revised for 2023 to read hospital observation and inpatient services.

 

[darcy-fortney@uiowa.edu]

I am still unsure what place of service will be required as well. I have been investigating and reaching out to payers directly and most of them seem to be completely unaware that there would be any change? It seems to me that we would have to bill POS 22 for patients in an observation status, and POS 21 for patients in acute inpatient status, but if anyone has found any published guidance, I would love to see it!

 

[JulieP]

I am still unsure what place of service will be required as well. I have been investigating and reaching out to payers directly and most of them seem to be completely unaware that there would be any change? It seems to me that we would have to bill POS 22 for patients in an observation status, and POS 21 for patients in acute inpatient status, but if anyone has found any published guidance, I would love to see it!

I am wondering the same thing. Under the current rules for patients documented as "Outpatient/Observation" we use POS 22 (Outpatient) on our E/M codes. Under the 2023 rules since inpatient codes 99221-99223 & 99231-99233 have been revised to include " inpatient or observation care," would we use POS 21 (Inpatient) for someone documented as Observation?

 

[Cindy01]

All of my claims are denying with wrong place of service?

 

[lgardner]

per ACS:

for 2023, the codes for reporting observation care services (99217–99220) will be deleted and observation care services will be merged into the codes previously used to report only inpatient care services (99221–99233, 99238–99239). See Table 1 for the revised 2023 code descriptors. Although the same code will be used to report either inpatient or observation care services, you will still need to know the facility status of the patient to accurately report the place of service code as either hospital inpatient (21) or hospital outpatient (22)

 

[Cindy01]

My patient is in observation used POS 22 billed 99222-99238 denied for wrong place of service. I did read Medicare isn't changing anything for admitting physicians, that they still use obs codes????????????? I'm so confused.

 

[thomas7331]

My patient is in observation used POS 22 billed 99222-99238 denied for wrong place of service. I did read Medicare isn't changing anything for admitting physicians, that they still use obs codes????????????? I'm so confused.

You're just going to have to fight it out with the payers who are denying these. The payers need to either 1) fix the error in their claims system and adjust your claims, or 2) give you written guidance that they want you to submit POS code 21 for patients in observations status.

These kinds of denials are a common thing during any significant change in coding. Payers are often unable to foresee the implications of the code changes and slow to recognize the error and get their systems updated. You just have to be patient and persistent with them, frustrating though that may be.

 

[rachaelwilleford]

They're not changing the requirement to report the admitting modifier or their 8-to-24 hour rule. They are adopting the coding changes for inpatient and observation care though per the CMS PFS Final Rule such as descriptor times, code level selection on mdm/time. The descriptor has been updated on the inpatient codes to include observation care. You would report the POS like you did before, using the appropriate code level based on medical decision making or time (when applicable) with the correct POS. Payers haven't caught up to the coding standards is the likely scenario.