Wiki Can someone tell me...

[Love Coding!]

What is the significant difference between:

Established patient (office or other outpatient visit) 99211-99215

and

Subsequent observation care 99224-99226

If both of these sets of codes are considered outpatient, when would be the appropriate time to use each of them?

Thank you!

 

[kevbshields]

The significant difference is that subsequent observation care requires a patient to be in observation status during the service (outpatient hospital). Too, if you read your subsection guidelines, you'll discover that these subsequent observation care codes are designed for the attending physician/service. I'm confident (though without my CPT at this moment) it directs other physicians involved in the patient's care while on observation status to report the appropriate 99201-99215 code for their services.

 

[mhstrauss]

What is the significant difference between:

Established patient (office or other outpatient visit) 99211-99215

and

Subsequent observation care 99224-99226

If both of these sets of codes are considered outpatient, when would be the appropriate time to use each of them?

Thank you!

Depending on the payer...

The subsequent obs care codes are generally only for the provider who put the patient into obs status; any other providers who are following the patient would use the est patient codes. However, some payers allow all providers to use the obs care codes.

Does that answer your question?

 

[Love Coding!]

Depending on the payer...

The subsequent obs care codes are generally only for the provider who put the patient into obs status; any other providers who are following the patient would use the est patient codes. However, some payers allow all providers to use the obs care codes.

Does that answer your question?

Thank you Kevin and Meagan,

My sister and I both work that involves auditing and billing and we were in disagreement on this one. Yes both of your responses answered my question.

Thanks again!