Wiki Consult while in Observation

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jeburke23

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I'm working on a case where the PT (11 yo) was originally admitted to the ER and the ER provider contacted for a consult the 1st provider (orthopedic). PT was moved to OBS and 1st provider preformed SX, after which the 1st provider sent for 2nd provider (pediatric) for consult for a general medical evaluation.

In the case of the 2nd provider (pediatric) would this fall under the IP/OBS 99252-99255 CPTs or the 99212-99215? PT has commercial INS. Neither provider has yet entered consult billing for this DOS.
 
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In an observation case, only the admitting service uses the IP/OBS codes, all other specialties will use the outpt visit codes. The consultant will use the 99212-99215/99202-99205, or the outpt consult codes 99242-99245, if your organization or the insurance carrier is still using them. Our providers use the consult codes but we have edits set up to capture those insurances that do not accept and the coders flip them over to the visit code.

My MAC Novitas answers this in their FAQs. If you have a different MAC, they may cover it as well but this accepted rule.
 
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JDACPC said:
In an observation case, only the admitting service uses the IP/OBS codes, all other specialties will use the outpt visit codes. The consultant will use the 99212-99215/99202-99205, or the outpt consult codes 99242-99245, if your organization or the insurance carrier is still using them. Our providers use the consult codes but we have edits set up to capture those insurances that do not accept and the coders flip them over to the visit code.

My MAC Novitas answers this in their FAQs. If you have a different MAC, they may cover it as well but this accepted rule.
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Thank you, that helped!
 
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