Wiki Billing Medicare for Outpatient Observation

[KMC0231]

Is it possible to be reimbursed for the observation discharge (99217) if our initial observation care (99220) was rejected because it was paid to another provider?

*Please note, our documentation supports the billing of 99220 and 99217.

In other words, will the physician who is reimbursed for the initial observation care be the only physician that is reimbursed for any/all observation services?

I greatly appreciate any help

 

[dclark7]

According to the Medicare Claims Processing Manual, chapter 12, Section 30.6.8 only the physician who admitted the patient to observation status may bill the observation code, all other physicians should bill the office/outpatient codes as appropriate.

The physician who did the discharge work would bill the discharge code and any other physicians who saw the patient prior to discharge would bill the office/outpatient codes.

 

[KMC0231]

Thank you for your help!

I also read the IOM with this information and was confused specifically about the discharge because of the following statement....

"Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient?s observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes. "

Because we have the supporting documentation, we are going to follow your advice and bill the discharge even though our initial was rejected. I appreciate your help! Thank you