Observation codes-Can anyone help

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skreimborg

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Can anyone help with this scenario? Medicare patient in observation area of the hospital facility for 2 nights and discharged on the third day. The provider coded a 99219 for the initial visit, and then a 99225 on the second day and finally a 99217 on the date of discharge. Medicare denies saying treatment was rendered in an inappropriate or invalid place of service. Do you think it's because on the intital dos (before being in observation) the patient presented in the ER ? Should the intital code be a 99221 or 99222 because the ER and obsesrvation services should not be billed separately? Any thoughts are appreciated.

Sally Kreimborg, CPC
Dallas Central Chapter
 
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No, I do not think it has to do with that. Did you verify that the POS was correctly in place as outpatient since this observation.

Also for Medicare, only the admitting providers should be using the observation codes, if it other than the admitting providers than then should be utilizing the outpatient office visit codes (only for Medicare).

The only way it should be 99221 is if it truly was admit to inpatient instead of observation. So if the orders are verified, then the next step would be to verify the POS.

Hope this helps>eventhough you probably already tried this. :)
 
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