Observation services and consultation help!

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Hello,

I need someone to review what I have posted and tell me if I am accurate in my way of thinking when it comes to the observation codes. Thank you!

The NON ordering physician comes in as a consultation during the observation period. Would the specialist bill the outpatient e/m codes 99201-99205 w/ POS 22?

My next question...

The NON ordering physician comes in as a consultation AFTER the patient has been admitted by the ordering physician. Would the specialist now bill the inpatient e/m codes 99221-99223 w/ POS 21?

Thank you!
 

rthames052006

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To answer the first question, the "consultant" would now bill outpatient codes as you mentioned but the POS is 22 for outpatient. I found this info in the IOM on CMS's website at:

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Chapter 30.6.8 this is the blurb I found

"Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient's observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes"
 

Love Coding!

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To answer the first question, the "consultant" would now bill outpatient codes as you mentioned but the POS is 22 for outpatient. I found this info in the IOM on CMS's website at:

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Chapter 30.6.8 this is the blurb I found

"Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient's observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes"
Hi Roxanne!

Thank you for responding...I had to ask you though the POS 22 would be for the E/M outpatient codes right? 99201-99205, 99212-99215

Then regarding my next question if the specialist is requested to do a consultation AFTER the patient has been admitted by the ordering physician, then at that point the specialist would use the inpatient care codes with POS 21 right? 99221-99223, 99231-99233

Thanks again! ;) I am fairly new to the observation codes and I truly appreciate your guidance. P.S. thank you for sending that link
 

Maryst

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I have a similar question. I work for a specialist. A patient was admitted to inpatient by a hospitalist but the specialist came the same day a did a consult. Would you code the specialist with a consult code or another code? I can't bill the initial inpatient or initial subsequent.
 

Lynda Wetter

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I have a similar question. I work for a specialist. A patient was admitted to inpatient by a hospitalist but the specialist came the same day a did a consult. Would you code the specialist with a consult code or another code? I can't bill the initial inpatient or initial subsequent.
I was under the impression that the admitting physician would apply the Initial IN PT code and any other specialist coming to see the patient would use the Subsequest codes.
 
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