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Observation f/u visit

  1. #1
    Phoenix, AZ
    Default Observation f/u visit
    Medical Coding Books
    Hello all:

    I have a dilemma and need some input, please. I work for a specialty group who see a lot of observation patients at the local hospital. Generally, these patients are seen late at night and are then discharged on the second day. I have been instructed not to bill the f/u day as 99212-99215 (outpatient service) because they are not being paid. However, my docs are spending the time with the patients and generally document very well. This is a billable service and needs to be paid. Does anyone have any ideas? Thanks in advance.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  2. #2
    Seacoast- Dover New Hampshire
    This is what we use. Do you need to appeal.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. Default
    If you look in the CPT book I believe page 13 you will see Observation or Inpt care services (including Admission & Discharge Service) at the very bottom they tell you to refer to codes 99218-99220 (initial observation) and 99217(observation discharge). I believe you can use these codes.

  4. #4
    I agree with Karen, you probably need to appeal.

    I would make sure everything is correct, ie place of service, then fight it out with the insurance.

    What type of rejections are you getting and is it just one carrier or multiple?

    Laura, CPC

  5. #5
    I agree with NIC21 - the patient is discharged from observation on day 2 and so 99217 should be charged to indicate this.
    If the patient were to be in observation for 3 days you would bill the initial observation (99218-20) on day 1, and established outpt (99212-15) for day 2 and the observation discharge (99217) on day 3.
    Last edited by Karolina; 06-26-2009 at 09:57 AM. Reason: typo
    Karolina, CPC, CPMA, CEMC

  6. #6
    Since the services are performed on different calender dates, it would be appropriate to report 99218-99220 and 99217.

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