AAPC - Back to school
Results 1 to 4 of 4

Thread: observational codes

  1. #1

    Default observational codes

    AAPC: Back to School
    If our specialist is requested to provide a consult for a patient in observational status
    what code do we use for the first date of service, subsequent days are 99224-99226.
    Your article did not address this code for specialist code in as far as I see. It really only address if I was the supervising physician. Perhaps I missed it. Thanks, Robin

  2. #2
    Join Date
    Apr 2007
    Daytona Beach, FL


    According to Highmark Medicare services they have instructed us that the Observation codes are only to be used by the physician supervising the patient's care at the hospital, including the new subsequent codes. If the patient is a Medicare patient, the consulting specialist would use the 99201-05 or 99212-15 series depending whether the patient is new or established. If the patient has commercial insurance, then you can still use the Consult codes 99241-45, if they accept them. Any subsequent visits would be billed with 99212-99215.
    Jodi Dibble, CPC

  3. #3

    Default obsevational codes

    Thanks for you input, so outpatient codes should be used for the first consult date.The subsequent codes were changed 2011 to 99224,99225,99226 they were listed in the Coding Edge Feb 2011 page 16. That is what confused me. They only listed information for supervising doctor first day consult observational status.
    Thanks, Robin

  4. #4
    Join Date
    Apr 2007
    Daytona Beach, FL


    Highmark Medicare had a recent Teleconference on Observation codes. If you go to this page:

    and then go to the area of Previous Teleconferences - Observation E/M Care for Practitioners - date 01/28/11, click on the hand-out and go to pages 16-17 and it will give you the information you are looking for. You can also print out the complete hand-out to reveiw. Highmark holds alot of informative Teleconferences and Webinars and you can earn AAPC CEU's if you need them. You may have to adpapt some of the information to your local MAC is some instances, but most of the info is basic CMS guidelines.

    Jodi Dibble, CPC

Similar Threads

  1. Replies: 4
    Last Post: 01-30-2015, 11:36 AM
  2. Reimbursement for consult codes vs medicare new office/hospital eval codes
    By cardiocoder in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-20-2014, 08:09 PM
  3. new observational codes
    By Robinznest in forum Billing/Reimbursement
    Replies: 2
    Last Post: 05-11-2011, 06:41 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.