Wiki OBS consult

[kslynn]

I have a pt who is on medical assistance and was admitted as an OBS pt by their PCP. The PCP requested a consult by a cardiologist who has seen the pt. within the last 3 years. My question is this, "Would the first dos for the consult still be a 9924_ code or a 9921_ code since the pt is not a new pt to the specialist? Also, concerning the specialist, would the subsequent dos be coded as OBS (99224 - 99225) or would it be coded as OP days (99212 - 99215)? If you could give me the documentation supporting your answer, I would really appreciate it. There has been a difference of opinion in our office as to whether the OBS codes should apply to both the PCP and the specialist or just the PCP.

Thanks,
Kathy Lynn, CPC

 

[AmandaBriggs]

Only the physician/group ordering observation services may bill the observation codes. All other physicians/APPs providing treatment bill the applicable OP codes 9920_ or 9921_ as appropriate depending on whether the patient is new to the provider or not. This is discussed in the Medicare Claims Processing Manual, Chapter 12, Section 30.6.8 which can be found here:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Hope this helps!

 

[cgaston]

It is also in the CPT Book instructions under the Initial Observation Care New or Established Patient

 

[kslynn]

Thank you so much for your responses. I will pass this info on.