Wiki Consultation in observation

[desertsteph65]

We did a consultation while a pt was in the hospital. We got a letter a couple weeks later stating the patient did not meet the criteria for an in-patient and thus was an observation pt. We changed our billing to reflect observation service instead of in-patient., 99218. We have now received a denial for this code stating that our doctor was not the admitting physician. Should we hjave used 99234 instead?

any help is greatly appreciated.

 

[Kisalyn]

Your consult codes are 99241-99245 when the patient is in observation at the hospital. If you were billing an admit code, then 99218 would be appropriate, but you stated the encounter was a consultation.

If the patient has Medicare or an insurance that doesn't accept consult codes, then you would need to look at the new patient (99201-99205) versus established patient codes (99212-99215).

 

[Naveen Rachagolla]

I agree with Kisalyn, consultations in observation comes as outpatient, and if the patient has medicarie then your codes will be 99201-99215 based on whether your physician has seen this patient before within the 3 years.