AAPC - Back to school
Results 1 to 5 of 5

Thread: Medicare Observation

  1. #1

    Default Medicare Observation

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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. #3


    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
    Join Date
    Apr 2007
    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. #5


    Thanks for your help!

Similar Threads

  1. Billing Medicare for Outpatient Observation
    By KMC0231 in forum Emergency Department
    Replies: 2
    Last Post: 01-14-2015, 12:57 PM
  2. Medicare observation codes
    By rfweissman in forum Billing/Reimbursement
    Replies: 1
    Last Post: 02-26-2012, 09:17 AM
  3. Medicare pt in observation (Consult)
    By daniel in forum E/M
    Replies: 0
    Last Post: 02-03-2011, 09:57 AM
  4. 16 days of observation status (medicare)
    By racheleporter in forum E/M
    Replies: 2
    Last Post: 01-11-2010, 06:34 AM

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.