Wiki Billing physician services while patient is under observation status at a hospital

[LeahJ123]

Hi all,
Physician was consulting on a patient listed as OBSERVATION STATUS within a designated acute care hospital setting. The hospital billed and was paid for observation Level of Care x 3 days. The Physician billed 99252 for consulting services for day 1 with POS code 22, and 99232 for day two with POS code 21.

I'm thinking that the physician should have billed 99218-99220 for day 1 with POS code 22 and 99211-99215 with POS code for day 2.

A coworker thinks it should be paid as billed due to "law of agency rule" and meeting medical necessity, because the facility was an acute care hospital irregardless of the fact the patient was in observation status within the facility.

I'm not understanding this, can anyone explain it to me please? Thanks for your help in advance!

 

[mcuffee]

The codes that should be used are 99211-99215 or 99201-99205, depending on whether the patient is new or established and POS 22. Only the physician who admitted the patient to Observation can bill 99218-99220. Hope this helps.

 

[ksarvis]

ICD10 coding when a pt is admitted to the hospital

Hi,
i work in a group practise doctors office. we also have doctors that we bill for, that see pts in the hospital/ER.
Our hospitalist admit pts, do subsequent visits and discharge pts. We were having a discussion on the ICD10 coding though.

if a pt is admitted to the hospital and our doctor is in charge of their care, would the ICD10 coding be based on InPatient? (meaning you CAN code "probable, possible, looks like") or because we are billing for a Hospitalist (but still coding 99221-99239 for inpatient CPTs), is the ICD10 coding considered Outpatient coding? (meaning that you CANNOT code "possible, probable" etc)?
please help.
thank you

 

[latoshac]

We run into this issue a lot. I have attached a flow sheet we use in the office. I hope it helps

 

[camillecoder@hotmail.com]

Hi,
i work in a group practise doctors office. we also have doctors that we bill for, that see pts in the hospital/ER.
Our hospitalist admit pts, do subsequent visits and discharge pts. We were having a discussion on the ICD10 coding though.

if a pt is admitted to the hospital and our doctor is in charge of their care, would the ICD10 coding be based on InPatient? (meaning you CAN code "probable, possible, looks like") or because we are billing for a Hospitalist (but still coding 99221-99239 for inpatient CPTs), is the ICD10 coding considered Outpatient coding? (meaning that you CANNOT code "possible, probable" etc)?
please help.
thank you

The third quarter 2000 Coding Clinic validates this guideline, stating, “When coding for physician services whether provided in the hospital inpatient setting or in the physician office, coders should be guided by the Diagnostic Coding and Reporting Guidelines for Outpatient Services (Hospital Based and Physician Office).”