CPT for E/M Medicare patient consultation in Observation Status

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2
Location
Las Vegas, Nevada
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0
Hello,
I do not know how to bill for a hospital consultation for a Medicare patient under observation status. Since Medicare does not pay for consult codes, and patient is not inpatient what is the correct code to use?, I was using observation codes but we got a denial because our doctor was not the admitting physician.

Our Dr. was called to see patient for a specialist consultation, please help.
 

hpycoder

Contributor
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14
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0
Cpc

I also bill for out-patient Consults as well for Medicare patients in OBSV status at the hospital. I use codes 99201-99205 if new and the established for such when applicable since Medicare no longer accepts the Consult codes. Hope this helps.
 
Messages
46
Location
Harlingen, TX
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0
Hi.

For a Medicare Patient...

If the patient is admitted for "observation" and your physician was asked for a consult, he would report from the INITIAL OBSERVATION section. If he does not meet all the criteria for an inital code as far as documentation, then he is able to use a subsequent observation code.

The physician who did the Admit would report modifier -AI on his claim.

Thank you.
 
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