Wiki Observation Modifier

[jmfarrer]

Could anyone pleae help with the modifier for observation code 99219. My physician is now being called in to consult on observation patients at the hospital and when I submit without a modifier, the claim is rejected. I was informed by MC that a modifier would be needed. I submitted the 27 modifier and it was rejected as "not appropriate ". Should I have used the 25 modifier?
Please advise.
Thank you

 

[mitchellde]

the 27 modifier is for facility use only. If the only service reported was the visit then there is no need for the 25 modifier. if your provider was the one that admitted the patient to observation then you should not be reporting the 99219. if you provider is a consulting provider for a patient that is in observation then if The payer is Medicare or a payer that follows Medicare policy on consultations, then you use the appropriate new or established visit level codes. If the payer allows the use of consultation codes then use the appropriate consultation visit level.. No modifiers need if this is the only service provided.