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observational codes

  1. #1
    Default observational codes
    Medical Coding Books
    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
    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
    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

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