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Billing A Consult In An Observation

  1. #1
    Default Billing A Consult In An Observation
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    IBC is denying consult code 99254 and place of service 21 for a consult service that was during a patient's observation stay. The provider actually saw her in the emergency dept. What code should be used?
    Thanks, Kellie

    Kellie Fry, CPC
    Billing & Coding Compliance Analyst

  2. #2
    Location
    Baton Rouge
    Posts
    1,239
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    Quote Originally Posted by kelliep View Post
    IBC is denying consult code 99254 and place of service 21 for a consult service that was during a patient's observation stay. The provider actually saw her in the emergency dept. What code should be used?
    POS for ED is 23, and the ED consult codes are 99281-99285.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  3. #3
    Location
    Louisville, KY
    Posts
    1,101
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    Observation is an outpatient service, meaning your E&M code is incorrect right off. Too, Observation is a status, not a physical location.

    99241-99245 are consultations that occur in the outpatient area (including the ER).

  4. #4
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    Quote Originally Posted by kevbshields View Post
    Observation is an outpatient service, meaning your E&M code is incorrect right off. Too, Observation is a status, not a physical location.

    99241-99245 are consultations that occur in the outpatient area (including the ER).
    Thank you Kevin. Incidentially, this payer was Medicare who does not accept consult codes. So what should we use instead?
    Thanks, Kellie

    Kellie Fry, CPC
    Billing & Coding Compliance Analyst

  5. #5
    Location
    Louisville, KY
    Posts
    1,101
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    You must then "crosswalk" or level your code to the 99201-99215 series, based on the latest guidance.

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