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Thread: Can codes be billed as Observation or strictly Inpatient

  1. #1

    Question Can codes be billed as Observation or strictly Inpatient

    AAPC: Back to School
    Looking for some help with specific codes being billed as outpatient (Observation), however the facility is stating that the codes should only be billed as inpatient. The codes in question are: 63075,22554,22845,and 20931.
    Also, 22524 and 76012. The physician office is mostly performing these surgeries on Medicare patients and billing as outpatient with reimbursement, however the facility (hospital), states they can only be reimbursed when billed as inpatient. I can't find anything that says we cannot bill these as outpatient, can anyone help with this dilema?

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    Code 63075 has an ASC status of X5, which means it is excluded from being paid to an ASC/OP facility. Codes 22554, 22845, and 20931 all have an ASC status of C5, which means they are IP codes only.

    22524 is a G2, non office-based procedure added in CY2008 or later, with payment based on OPPS relative payment weight - which is not on the ASC approved list, so is also IP only.

    You can find these on the CMS site: http://www.cms.gov/ASCPayment

    I hope this helps.
    Last edited by cmcgarry; 05-06-2010 at 08:11 AM. Reason: corrected info after checking CMS site
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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