Wiki E/M Question

[kellstar36]

Can consultations or follow up visits be done in an outpatient facililty, with no procedure performed, and get reimbursed for it? Or can they only be done in the office in order to be reimbursed?

 

[tpontillo]

Yes you can do these in outpatient settings. The descriptions for 99201-99215 is office visit or other outpatient visit. I have been getting paid but some insurance companies just look at the code and process it as an office visit. I do have to fight for them to process the claims as an outpatient. This is not with all insurance companies. Medicare does pay for these codes in an outpatient setting

 

[RebeccaWoodward*]

Consultations and outpatient codes are billable in the outpatient setting. Medicare no longer pays for consultations, however.

"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.

For example, if an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial observation care code. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate."

Page 52

https://www.cms.gov/manuals/downloads/clm104c12.pdf

 

[FTessaBartels]

Pos 22

Make sure you are using the correct place of service code.
22 - outpatient hospital
11 - physician office

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[kellstar36]

Thanks tpontillo for responding back, but one question....what place of service were you using in the outpatient setting 11 or 24? Please let me know. Thanks.

 

[tpontillo]

I use place of service 22