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E/M Question

  1. #1
    Default E/M Question
    Medical Coding Books
    Can consultations or follow up visits be done in an outpatient facililty, with no procedure performed, and get reimbursed for it? Or can they only be done in the office in order to be reimbursed?

  2. #2
    Location
    Lauderdale Lakes
    Posts
    203
    Default
    Yes you can do these in outpatient settings. The descriptions for 99201-99215 is office visit or other outpatient visit. I have been getting paid but some insurance companies just look at the code and process it as an office visit. I do have to fight for them to process the claims as an outpatient. This is not with all insurance companies. Medicare does pay for these codes in an outpatient setting

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    Consultations and outpatient codes are billable in the outpatient setting. Medicare no longer pays for consultations, however.

    "Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient's observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes.

    For example, if an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial observation care code. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate."

    Page 52

    https://www.cms.gov/manuals/downloads/clm104c12.pdf

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Pos 22
    Make sure you are using the correct place of service code.
    22 - outpatient hospital
    11 - physician office

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Smile
    Thanks tpontillo for responding back, but one question....what place of service were you using in the outpatient setting 11 or 24? Please let me know. Thanks.

  6. #6
    Location
    Lauderdale Lakes
    Posts
    203
    Default
    I use place of service 22

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