Wiki Consulting Physican billing for subsequent visits

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grogans04@aol.com

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Hello, Can a Consulting physician who see's a patient in Observation bill for a subsequent visit the next day using Observation subsequent visit codes? He is NOT the admitting physician? I am getting conflicting answers...Thanks!
 
You would need to check with your insurance carriers. Medicare will only allow the physician who placed the patient into observation to use these codes. Other providers should use codes 99212-99215 for subsequent visits. Other carriers may have different reimbursement policies.
 
I billed all the time for consulting physicians seeing a patient after the initial consult but still in observation using subsequent care observation codes. I'm in Virginia. However if insurance only approved outpatient level, we would use 99212-99215 codes. But no issues if observation status was approved billing observation codes.
 
the rule is only the physcian admitting the pt into obs status can bill the obs initial code; I coded/billed rounding and I only have had issues with getting Medicaid plans to pay sub obs codes. When this happens, they get changed to outpt codes.
 
teresabug said:
the rule is only the physcian admitting the pt into obs status can bill the obs initial code; I coded/billed rounding and I only have had issues with getting Medicaid plans to pay sub obs codes. When this happens, they get changed to outpt codes.
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What if the providers are in the same practice? Same TIN?
 
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