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NEW Subsequent Observation Care CPT codes

  1. #1
    Default NEW Subsequent Observation Care CPT codes
    Medical Coding Books
    What if anything have you heard about the new Subsequent Observation Care? i am under the understanding that now when the initiating provider request another provider to see the patient instead of using the OP New or Establish codes 99211-99215/99201-99205 the provider is to use the Subsequent Observation Care codes 99224-99226.Please let me know what is being discussed on this issue. Thanks as always for your help

  2. Default
    I would like to know the answer as well, in 2010 CPT it stated only admitting dr. would use the observation codes but in the 2011 CPT it no longer states that so are we to be using these codes for observation days 1,2,3..? Thank you, Gail

  3. #3
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    North Carolina
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    I would check with your Medicare carrier. I am hearing that CMS has made the comment that subsequent observation codes can only be used by the admitting physician.

    It's my understanding that WPS issued this statement in an "E News" bulletin....

    "Only the physician admitting the patient to observation care status may bill the observation procedure codes. This includes the admission (99218 - 99220), subsequent observation (99224 - 99226), and discharge from observation (99217) procedure codes. Anyone else seeing the patient while in observation care would bill using an office or other outpatient procedure code 99201 - 99215 as appropriate."

  4. #4
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    Rebecca, that is my understanding as well.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    North Carolina
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    Discussion in progress...

    Are you finding that commerical carriers are allowing a different provider (other than the admitting) to report the discharge (99217)?

  6. #6
    Location
    Columbia, MO
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    I have not found that to be the case with the ones I have billed. They all had to be changed, not that there were that many but it got to the point that I knew when I heard about the denial how to fix it.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    North Carolina
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    Thanks Debra!! I appreciate the feedback!

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