ksschroeder
Networker
What CPT code would you use for a patient seen in consultation while in observation and the insurance company does not accept consult codes?
My doctor did a level 4 consultation on a patient in observation who has BCBS ins. He did not initiate the observation care. We are debating whether to crosswalk the code to 99219 or 99226.
CPT guidelines for Initial Obs Care (99219) indicate the only the supervising physician should report the initial obs codes and that obs encounters by other physicians should see office or other outpatient consult codes (99241-99245) or subsequent obs care codes (99224-99226).
Some of us believe 99219 should be used since it is the same level of care as 99244, and some of us believe 99226 should be used since that is where CPT directs us even though the level of care is less.
I am wondering what others are using in this circumstance?
Thank you,
My doctor did a level 4 consultation on a patient in observation who has BCBS ins. He did not initiate the observation care. We are debating whether to crosswalk the code to 99219 or 99226.
CPT guidelines for Initial Obs Care (99219) indicate the only the supervising physician should report the initial obs codes and that obs encounters by other physicians should see office or other outpatient consult codes (99241-99245) or subsequent obs care codes (99224-99226).
Some of us believe 99219 should be used since it is the same level of care as 99244, and some of us believe 99226 should be used since that is where CPT directs us even though the level of care is less.
I am wondering what others are using in this circumstance?
Thank you,