Results 1 to 2 of 2

Observation vs. outpatient physician billing in hospital setting

  1. Smile Observation vs. outpatient physician billing in hospital setting
    New Call-to-action
    I do billing for a group of hospital based physicians (hospitalists). We have one facility that is notorious for having patients admitted under "extended hospital outpatient" status. Most often these are placement issues - not accepted by SNF, not appropriate for rehab, no family to care for them, etc. Oftentimes the patients start out as inpatient, but then outpatient orders (NOT observation) are dropped as the patient no longer meets inpatient criteria.

    We have had a very difficult time finding clear documentation on how to bill these services. Initially we thought that the claims would be billed as observation follow up's (99224-99226); however, the more we are looking into this, it seems as though we should be billing 99212-99214. Does anyone have resources regarding this situation (especially for Medicare patients)?

    Thank you!

  2. #2
    Dover Seacoast New Hampshire
    Medical Billing
    EXT (Extended Care) is an outpatient status, not an Observation status, and thus you would use the 99212-99215 code sets. The Observation codes in CPT are specifically for patients admitted to observation, which is a different level of care than EXT. I don't have any resources right off the top of my head, but know this from the perspective of patient care in the facility. I'll look around, though.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

Similar Threads

  1. Physician billing: inpatient, observation, or outpatient
    By in forum Billing/Reimbursement
    Replies: 0
    Last Post: 07-16-2018, 01:54 PM
  2. Replies: 4
    Last Post: 01-10-2018, 03:21 PM
  3. hospital outpatient setting chemotherapy
    By jhkimmc in forum Hematology/Oncology
    Replies: 0
    Last Post: 12-11-2013, 06:13 AM
  4. Replies: 1
    Last Post: 11-25-2009, 05:46 AM
  5. Modifier 51 in Outpatient Hospital Setting...
    By nycoder in forum Modifiers
    Replies: 5
    Last Post: 09-16-2008, 11:54 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.