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Thread: Observation Status

  1. #1
    Join Date
    Apr 2007

    Default Observation Status

    AAPC: Back to School
    Orthopedic surgeon is asked to see a patient who is in the hospital under "observation" status. The patient is there for 3 days. Doctor sees the patient each day. What code series should be billed for day 1.... what code series for each additional day ? Also for claim submission would the Place of Service be "outpatient" or "inpatient" ?
    Lots of different opinions on this scenario going on here regarding correct way to bill.
    Thanks for any feedback !

  2. #2
    Join Date
    Apr 2007


    Who is your carrier? Was it a consult or transfer of care?

    For Medicare, I just sat thru a webinar from Highmark Medicare, stating that in obs you only use the outpatient E/Ms unless you are the provider that put them in obs (99201-99215). I am going to research this for other carriers though since this is the first I had heard of it.

    For commercials, if you have a consult you would use the outpatient consult (99241-99245) for day 1 then established outpatient 99212-99215 for days 2 and 3. If it was a transfer of care you would use the correct outpatient E/M (99201-99215) for day 1 then the established outpatients for days 2 and 3.

    Laura, CPC, CPMA, CEMC

  3. #3
    Join Date
    Apr 2007


    For this case Medicare is the carrier and it was a consult.

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