Wiki BCBS denial for initial observation

[staylor2017]

Our claims are being denied due can only be charged once per stay. The charge is from a different phyisician that is not in our group of specialist. How do we get around this? We are not the attending physician nor the admitting.
BCBS is wanting documentation.

 

[twizzle]

Only one provider (the admitting) can bill an initial observation code 99218-99220. Everyone else should bill a regular outpatient/office code - new/established patient (2021 E/M guidelines), or a consult code if applicable (95/97 guidelines).

 

[staylor2017]

Only one provider (the admitting) can bill an initial observation code 99218-99220. Everyone else should bill a regular outpatient/office code - new/established patient (2021 E/M guidelines), or a consult code if applicable (95/97 guidelines).

We didn't start getting these denials until recently. I thought as long as the taxonomy code was different then they would pay.

 

[sls314]

We didn't start getting these denials until recently. I thought as long as the taxonomy code was different then they would pay.

No. Only one physician can bill the initial observation code.

The guidelines for Observation coding are in the CPT book - you can find the information above on page 21 of the 2022 CPT book if you need to review further.

 

[staylor2017]

No. Only one physician can bill the initial observation code.

The guidelines for Observation coding are in the CPT book - you can find the information above on page 21 of the 2022 CPT book if you need to review further.

Funny thing is we are just now reading that page. Thank you!

 

[staylor2017]

Funny thing is we are just now reading that page. Thank you!

Would a ER visit 99285 be considered an initial visit?

 

[vandenmj]

99285 is for emergency room care. Multiple providers can bill this code if they are providing emergency care in the emergency room (POS 23).