Wiki Outpatient consultation question?

[pmartinez]

I am working on RAC Audits here is the situation and I'm not sure how to handle this.

"
I am coding the professional services not the facility."
Patient is admitted to facility A and during the admission they are brought to facility B (totally separate facility) for a consultation by a specialist (neurology). They are at facility B for 2 days in observation status.

Those 2 days of observation are billed as observation visits 99219 & 99217 with place of service 22 out patient.

According to the RAC audit we are getting the recoupments due to "observation care codes are not billable for patients in an inpatient hospital setting."

The patients are not inpatient with facility B only with facility A. But since they are inpatient status with facility A would facility B bill with inpatient place of service?

Any help and/or something in writting to help me is appreciated.

Thanks.
Patti,

 

[slpagel]

Outpatient

I had a similar situation with a long term care facillity and the hospital. If I remember correctly the Hospital had to send their bill through the long term care facility. I believe all the out patient charges in your case needs to be billed as if they were being seen at the at the Inpatient facillity.