Wiki Next day OBS discharge

[mooney2013]

My Doc did a Cardiac Catheterization and the patient had to stay overnight in OBS I billed 93458-26 for the 1st day and a 99217 for the next day. UHC is refusing to pay the 99217 stating it is not supported,and that he did not indicate that an OBS day management was performed, they also said there was a better code to use. I had sent all the medical records the cath report and the discharge summary which included all the elements required per the CPT definition for 99217. Can anyone tell me what I am missing in order to get this paid.
Thanks
Kay

 

[CodingKing]

I don't believe you can report an E&M code for post op observation.

 

[danskangel313]

You'd have to include the admit code on day 1, otherwise the 99217 on day 2 has nothing to match up to. Also, the patient has to actually be in observation status to code for that.

Also, the admit to observation codes bundle with the procedure but the edits say a modifier is allowed.