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Medicare Observation

  1. Default Medicare Observation
    Medical Coding Books
    Hi, we do billing for a hospitalist group who is usually the main care provider for patients who are in observation status in a hospital setting. We bill all observation codes 99217-99220, 99224-99226, and 99234-99236. We have been getting some denials from Medicare with denial code 125. Called Medicare and they are stating that the observation claim is denied because they only allow ONE observation code per day. Unfortunately, when the patient is in observation status, other specialists also bill these codes. For example a cardiologist would bill a 99220 for observation care, and we also bill it for Internal Medicine. Although, it is a different specialty group, they are still denying it for only one obs code per day. We have done redeterminations with medical records and they are not working.

    Has anyone else found a solution to this problem? Or experiencing the same?


  2. #2
    Columbia, MO
    only the admitting/attending provider can bill the observation codes, other providers seeing the patient in observation use office visit levels with POS 22.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    The only problem is that the specialists are not following those rules and they are the ones that should be billing the office codes, not us. I guess their claim gets there before ours does.

  4. #4
    Columbia, MO
    That would seem to be the case. But now you know the basis of your appeal. That is go from the stand that you were the admitting/attending for the observation, your orders in the chart should support this by stating "admit to observation for".....

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    Thanks for your help!

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