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Wiki Observation Codes

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nantes1993

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Patient admitted to observation on 8/5/15 using code 99218.
Another provider was asked to provide a consult on 8/6/15 which that provider billed a 99226. Patient was discharged later on 8/6/15 in which 99217 was billed.
Denial is stating the 99217 and 99226 are incidental and are not payable in this situation.
What other way can this be billed?
Thank you.
 
The consult was billed incorrectly. It should be billed using regular OV codes with outpatient POS. Only the provider that admits the patient to observation can use observation codes.
 
Yes, Debra is correct with this instance. Please look up MLN Matters MM6740 Revisions to Consultation Services Payment Policy. Page 4 (first bullet) explains the logic for billing Observation services for consultants.
 
Agree. The 99226 was billed incorrectly. That provider will need to bill 99201-99205 if it's a new patient or 99211-99215 if he or she has seen the patient before.
 
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