Established patient codes (99211-15) vs Subseq hosp codes (99231-33) for outpt stay

[sawils]

Question pertaining billing established patient codes versus subsequent hospital codes for an outpatient stay, POS 22:

Why we would use E/M 99212-99215 with POS 22 instead of the subsequent observation care codes 99224-99226? Is there an advantage of using one set of codes over another, or specific rules for why we would use one set over the other?

Thanks in advance for any advice--

 

[kbartrom]

Per Medicare's Claims Prosessing Manual, Chapter 4, Section 30.6.8:

B. Physician Billing for Observation Care Following Initiation of Observation Services
Similar to initial observation codes, payment for a subsequent observation care code is for all the care rendered by the treating physician on the day(s) other than the initial or
discharge date. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill
the appropriate outpatient service codes.

If following Medicare guidelines, the provider (or provider with same tax ID, same specialty) who placed the patient in obs uses the subsequent obs codes. All other providers seeing the patient use the outpatient EM codes.

Hope this helps!

 

[sawils]

Thank you, KBartrom, for taking the time to provide a response. I appreciate it very much!