Oncology & Hematology Coding Alert

Question: How should I code a consult my physician performed for a patient admitted for an observation stay?


Wisconsin Subscriber

Answer: Fight the temptation to report observation codes 99218-99220 (Initial observation care, per day ...). Payers consider a consult while the patient is in observation to be -outpatient,- so you should report 99241-99245 (Office consultation for a new or established patient ...).

If the patient is admitted, report the consult with an -inpatient- code (99251-99255, Initial inpatient consultation for a new or established patient ...).

Only one physician should report an observation admit code per observation stay.

Note: If your physician admitted the patient, you should report an admission code (99221-99223, Initial hospital care ...) instead.