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Subsequent observation code 99225

  1. Default Subsequent observation code 99225
    Medical Coding Books
    I need help in finding the rule on how many Doctors can bill a 99225 subsequent observation care on a single day. I am getting a denial stating this service exceeds the maximum number of units allowed per day. Customer Service says they only pay for one doctor per day. This can not be true?
    Please someone tell me where on CMS I can find this rule, or how to correctly bill for this, my doctor did the work he should get paid.

  2. Default

    Contractors pay for initial observation care billed by only the physician who ordered hospital
    outpatient observation services and was responsible for the patient during his/her observation
    care. A physician who does not have inpatient admitting privileges but who is authorized to
    furnish hospital outpatient observation services may bill these codes.

    Another provider has billed for that service already so your claim comes back as the denial.

  3. Default Follow Up Question
    Will CMS reimburse doctors of the same "group" but different specialty for a same day Observation follow up code (given that they have separate taxonomy and specialty codes)?

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