Wiki Hospital coding need emergent response.

[hawkinsj]

Can a 99204 be billed day one for surgeons patient to consult on patient that surgeon admitted as observation followed by 99232 for rounding on day two. I say no. The consult should be billed in its own event as a consult by the Hospitalist and then start a new event on day two for Hospital service as patient had been changed to in patient status. Would appending a modifier clear up confusion to the payer? Please site your point of reference.

thanks so much,
Janet

 

[OCD_coder]

Let me be sure I am reading your question correctly. The surgeon is the admitted physician on Day 1 for observation?

If yes, then if he performed a consult and the payor accepts consultation codes a consult code would be appropriate. If the payor does not accept consultation codes, the observation code family should be utilized only for the physician directing observation care.

If no, the hospitalist will bill the observation codes and the surgeon would bill for an outpatient encounter (99201-99215 new or est) if consults are not allowed by the payor.

Day #2 - identify who the admitting physician is and bill an Initial Inpatient CPT code for that physician and the other physician will bill a subsequent CPT code.

* There was an article not too long ago in the Coding Edge magazine regarding how to bill for Observation codes.
Another source to get you started is:
https://www.oxhp.com/secure/policy/observation_care_e_m_codes_311.html