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Thread: consultation for medicare patient in observ

  1. #1

    Default consultation for medicare patient in observ

    AAPC: Back to School
    Specialist called in to consult a medicare patient who is not admitted but still in observation status at hospital.

    2010 codes have changed not to include consults:

    Do you bill with 9921### what ever level and pos as 22 and are you being paid by medicare?

  2. #2
    Join Date
    Apr 2007
    Green Bay


    You would have to bill either the 99201-99205 or 99211-99215 range of codes depending on whether the patient is new or established and yes, with POS 22.

    I haven't come across any issues.

    Jessica CPC, CCC

  3. #3


    Why would we not use the observation codes? If doctor comes to see patient in observation on day one say.... level 2, then day two sees patient level 1, couldn't you code 99219 and day two code 99218?

  4. #4
    Join Date
    Apr 2007
    Green Bay


    I think that codes 99218-99220 can only be reported by the physician who is actually admitting the patient to observation status.

    Plus these codes are for INITIAL observation care, so you can't use the code AGAIN on the next day.

    Per CPT "For observation encounters by other physicians, see Office or Other Outpatient Consultation codes (99241-99245)." Hence you will for Medicare have to use either the new or established patient codes as appropriate.

    Medicare also says "Physicians and qualified NPPs should report Office or Other Outpatient Visit using a code from CPT code range 99211-99215 for a visit before the discharge date in those rare instances when a patient is held in observation status for more than two calendar dates". MLN Matters Number 5791.

    Jessica CPC, CCC

  5. #5

    Default lrk63

    When did MCR stop accepting the 9920x codes as replacement codes for the 9924x series? It seems they want all to use 9921x, regardless of new or est.

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