out patient or ambulatory stay

[tobieforte]

I was told by a co-worker of mine that if a patient is in the hospital but considered out patient or in for an ambulatory stay, we could use 99211-99215 since the definition is "office or other out patient visit". Can anyone confirm that this would be okay to use when the pt is in the hospital?

 

[orthobiller2000]

you can refer to http://www.cms.gov/MLNMattersArticles/downloads/MM7405.pdf regarding use of new subsequent observation care codes.

For example If an internists orders observation services, furnishes the initital evaluation and asks another physician to additionally evaluate the patient, only the internist may bill the initial observation care code. The other physician who evaulation the patient must bill the new or estabilshed patient office or other outpatient codes as appropriate.

Hope that helps

 

[tobieforte]

Your answer helped but what if the pt is not considered observation, just ambulatory and in for an elective reason. Are out patient stays suppose to be considered observation and therefore use the observation codes as opposed to the office/out pt service codes of 99211-99215?? I do read in the 2013 CPT book under "office and other out patient service" codes "A patient is considered an out pt until inpatient admission to a health care facility occurs" which leads me to believe that I should use the 99211-99215 codes. What are your thoughts??

 

[tobieforte]

Okay, thanks so much!