# Facility coding / Physician coding



## Love Coding! (Nov 9, 2012)

Please check off below as to which this guideline applies to please?

_Probable, suspected, rule out, working dx_

*1.  Inpatient (facility) coders:*
AI - 99221-99223 Initial 
      99231-99233 Follow up

Observation-
99218-99220 Initial 
99224-99226  follow up

*2. * *Patient is "inpatient" status and a consultant that does not work for the hospital is called in to see a patient.  (non-facility physician based coding)*
99221-99223 (without AI modifier)
99231-99233

*3.  Patient is in "observation" status and a consultant that does not work for the hospital is called in to see a patient.  (non-facility physician based coding)*
99201-99205 = A patient that has never established care before with the rendering physician in the hospital or office beyond three years.

99211-99215 = A patient that has established care with the rendering physician within the past three years whether in the hospital or physician office.

*4.  Outpatient = Physician office, outpatient facility*
99201-99205
99211-99215

Your help is greatly appreciated!


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## btadlock1 (Nov 9, 2012)

Cici CPC CPMA said:


> Please check off below as to which this guideline applies to please?
> 
> _Probable, suspected, rule out, working dx_
> 
> ...



Observation is the same as inpatient status, for the purposes of ICD-9 coding (both require a "discharge") - so, suspected conditions apply to both settings, regardless of whether the provider is the admitting, attending, or just a consultant. 

There is no such thing as a 'suspected condition', in outpatient ICD-9 coding - they either have it, or they don't. Hope that helps!


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## mitchellde (Nov 9, 2012)

I am not sure I understand your scenario here but only facility inpatient coders can code probably suspected and rule out diagnosis as though they exist.  
Your response #1  does not make sense as a facility coder will not use any of those codes listed in that choice


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## btadlock1 (Nov 9, 2012)

Cici S said:


> Please check off below as to which this guideline applies to please?
> 
> _Probable, suspected, rule out, working dx_
> 
> ...



I'm curious about something, though - why would you use outpatient office E/M codes for a patient in observation, instead of a consultation code? Medicare?


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## mitchellde (Nov 9, 2012)

btadlock1 said:


> Observation is the same as inpatient status, for the purposes of ICD-9 coding (both require a "discharge") - so, suspected conditions apply to both settings, regardless of whether the provider is the admitting, attending, or just a consultant.
> 
> There is no such thing as a 'suspected condition', in outpatient ICD-9 coding - they either have it, or they don't. Hope that helps!



Observation from a facility perspective is outpatient so the guideline of suspected probably or possible does not apply,  from the physcian perspective it has discharge codes but is still an outpatient POS and the guideline for uncertain diagnosis does not apply to physician coding regardless of setting.
so to clarify
the coding of uncertain diagnosis (suspected, possible, rule out, etc) may be coded as though they exist by the inpatient facility coder only.  Outpatient cannot and physician coders cannot regardless of POS.


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## Love Coding! (Nov 9, 2012)

btadlock1 said:


> I'm curious about something, though - why would you use outpatient office E/M codes for a patient in observation, instead of a consultation code? Medicare?



Hi Brandi,

The coding circles I have been around this is considered a "hot" topic.  Here is the CMS link with more information, my carrier is Noridian - AZ.  Thank you for responding 

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/MM6740.pdf


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