Wiki Observation

[01065679]

Observation coding question.....Patient is in Observation and is being followed by the Hospital Med staff. They call for a consult to nephrology on day 1 and the nephrologist bills out a consultation/new patient visit.
The second day the patients gets a dialysis treatment.
Patient is still in observation status on the third day and the nephrologist does a follow-up. Would he bill an established outpatient code 99212-99215 or a subsequent observation code 99224-99226?

 

[crchandl]

Is this a Medicare patient? If so...

Only the physician admitting the patient to outpatient observation care (or a member of the same group with the same specialty) may bill the observation CPT procedure codes. This includes the admission (99218 - 99220), subsequent observation (99224 - 99226), and discharge from observation (99217) CPT procedure codes. Anyone else seeing the patient while in observation care would bill using an office or other outpatient procedure code 99201 - 99215 as appropriate.

The Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 100-04, Chapter 12, Section 30.6.8