Observation - Subsequent Obs - Admission by Consulting Provider


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Dilemma outpatient overnight observation, subsequent observation, and admission by another provider. ED provider sees patient 15:00 hrs on DOS 1.13 , admits and follows patient in observation Dos 1.13 at 18:15 (initial obs). DOS 1.14 08:00 OBs attending orders cards consult. 1.14 08:30 Cards sees patient orders thallium stress test. 1.14 ED/OBs attending sees patient at 09:30 states pt awaiting cards consult, and stress test, disposition pending cards consult. 09:45 Stress test completed, cards decides to admit patient to inpatient status. Ed/obs provider sees patient again and states pt failed observation period and will be admitted per cardiology consult 1.14 at 11:00. The ED provider can code the initial observation service code 99218-99220 for 1.13 18:15 since they follow pt in observation, and a subsequent observation code set for the services they provide on the subsequent date 1.14. I know the provider cannot charge the DC. And if the Ed provider was the admitting provider then they could not charge for subsequent observation services. Any help would be greatly appreciated.