Question Observation admission

wynonna

Expert
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Hinsdale, MA
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Our MD "put a patient" in observation.
Hospital MD signed H&P, and our MD cosigned H&P. Our MD also cosigned a consult note from same date.
Would this be billed in 99218-99220 range for initial Observation? Are we combining elements from both notes? Billing 99218-99220 or 99202-99205?
thank you
 

natashalage

Networker
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Walnut Creek, CA
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I would like to continue this dialogue since nobody answered yet, but I am a new coder so my answer is not to follow by. I am looking forward to seeing more responses here. My thinking is : if your MD had Consult note and then he puts pt in Observation for the same Dx, I think we should combine both notes and bill with Initial Observation CPT. I remember reading CMS that Other specialties should use output E/M 99202-99205 when pt is in Obs.
 
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Looking at pg 21 of the E/M guidelines 2021 CPT manual, highlighted in green: "EM services including new or established patient office or other outpatient services...on the same date related to the admission to 'observation status' should not be reported separately." I'm also new, so wondering if this means you cannot use 99202 with 99218. Is this right? Any advice/comments appreciated.
 

psd

Contributor
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Spokane, WA
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Hospital MD signed H&P, and our MD cosigned H&P. Our MD also cosigned a consult note from same date.
I'm unclear what you are meaning when you say your provider co-signed both an H&P and consult... whomever performed the H&P for Observation admit, they would be the provider to bill the 99218-99220. Only one provider can bill this code per admit.

Either way, if your provider saw the same patient more than once on the same day, you still only bill one E&M code. (there are some exceptions, but generally not for Observation)
As you said in your last post, you would combine the elements of History, Exam, MDM to get the highest level.
If the Hospital MD already billed 99218-99220, depending on the patient's insurance you could bill a Consult (99241-99245), a New Patient (99202-99205) *if they are new to your provider* OR an Established visit (99212-99215).
 
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