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Thread: Physician Consultations during Outpt Observ

  1. #1

    Default Physician Consultations during Outpt Observ

    AAPC: Back to School
    According to CMS policy 100-4, 12, 30.6.8 only the phys ordering the observation svc can bill the observ codes of 99220-99226 - all other physicians that consult or see the pt during this time must bill regualar outpt codes - can anyone tell me what place of service they should use for these consults - 22?

  2. #2


    Use the 22 place of service to bill the consultation. however if you are billing a insurance
    company that does not accept consult codes you must bill outpatient E/M services for new or established patient. ie 99201-99205 or 99211-99215

  3. #3


    Thanks so much!

  4. #4
    Join Date
    Apr 2007
    Manhattan, NY


    Do not forget to append the AI modifier to E&Ms for those carriers not honoring consult service CPTs! Per Medicare:

    "Can you confirm when I’d use the AI modifier?

    The AI modifier (Principal Physician of Record) is appended by the principal physician of record to the evaluation and management (E/M) code. Medicare defines the principal physician of record as the physician who oversees the patient’s admission and care."

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