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Wiki Outpatient/Observation Consultation

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bda23054

Networker
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Lebanon, MO
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I am coding for a client that does not bill Consultation codes to any insurance, based on Medicare guidelines.
Case Scenario -
Physician admits to OBSV/OUTPATIENT status and requests Consultation by Hospitalist for management of other medical problems. What range of codes would you use for the Hospitalist consultation?
I'm getting different opinions from other coders and wondered what everyone else thought.
I have always billed the NEW/EST Office Outpatient Codes (99201-99205/99212-99215) and have never received a denial from any insurance company. Others have stated to use range 99218-99220 but guidelines state those codes are to be used by initial admitting (obsv) physician only.
Your thoughts?
 
Hello bda,

I agree with you in your manner of billing for this scenario. If the place of service is the ER, an ER code could also be used (which may be higher reimbursement).

I hope this helps,

Michelle
 
I agree that only the admitting provider can use code range 99218-99220. That also goes for the use of the subsequent observation codes 99224-99226. It sounds like the Hospitalists are being asked to assume a transfer of care for management of co-morbidities. In this case, you're correct in reporting either new patient or established patient office/other outpatient codes (99201-99215).

Tori Davis
CPC, CGIC, CGSC
 
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