Wiki OBS coding with Prolonged visit


Phoenix, AZ
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Per CPT 2012, Prolonged service code 99356 can be used in conjunction with CPT 99221-99233. This includes code 99226, Subsequent Observation Care.

I submitted a charge to Medicare for 99226 and 99356, POS 22 (outpt hospital); the claim was denied for 99356. Reason: procedure code is inconsistent with the POS. After calling Medicare, the most recent information she could find was in Bulletin 246, June 2008. This gives direction to use cpt code 99354 Prolonged service in the office or other outpatient setting....

This can't be correct!!! The Observation code I'm trying to bill didin't exist in 2008; these are new as of 2011. Does anyone have any further ideas on how I may get this billed? Should I appeal to Medicare with copies of 2012 CPT attached? Actually, I can't appeal; the claim is unprocessable, must submit a new claim with corrected info.

The gal from Medicare did suggest to use the 99354 code, which for 2012 does not include 99226 in the "use in conjuntion with" list....I just can't believe that will be processed....I guess I should....since Medicare is using info from 2008...??? Any thoughts appreciated!!!