Wiki Arkansas Medicaid and Observation Codes

[leo061108]

I have a question about Observation codes. I work in a Cardiology office and my doctor consulted on a patient at the hospital that was in Observation status - insurance is Medicaid. My understanding is that for an observation consult when your doctor is not the admitting physician, you would use the out patient consult codes 99201-99205 for new or 99211-99215 for established. However, it is also my understanding that Medicaid does not accept these codes in a hospital setting, so is there a different set of codes that I should be using for Medicaid?

 

[SharonCollachi]

I am running into a similar situation where my state medicaid (California Medi-Cal) says certain codes are not payable in a hospital setting. I found in their billing guide that I have to use a "U2" modifier. HOWEVER, after I rebilled all my denied codes, they were denied again for the same reason. A call to Medi-Cal revealed no new information, they said to appeal.

I would suggest you search through your Medicaid manual for the U2 modifier.