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Wiki Medicare and Subsequent Observation Codes
- Thread starter carelitz
- Start date
carelitz
Guest
No one knows?
thomas7331
Guest
Here is the official guidance from Medicare on this: https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/MM6740.pdf
I'm assuming you are inquiring specifically about consulting providers in your question. The situation of the observation patient is addressed at the top of page 4 and it while it says that only the admitting provider may bill the initial observation care codes, it does not address whether or not consulting providers may bill the subsequent observation care codes. I would assume this means that they can, but not having direct experience with that situation, I am not sure whether or not specific payers or contracts might deny them for non-admitting providers as duplicate services. In the practice where I worked, we would have billed the outpatient codes 99212-99215 for all follow-up consulting physician services to Medicare outpatients in observation status.
I looked over your attachment and although it is correct for patients in observation, you've indicated 'outpatient' and I would just note that it is not quite correct for outpatient situations where the patient has not been admitted to observation status. In cases of outpatients not admitted to observation, 99224-99226 would not be appropriate for follow-up care, whether Medicare or non-Medicare, and consulting physicians should use 99212-99215. Also of note, in the case of initial consultations for Medicare patients, 99281-99285 would be used instead of 99201-99205 for Medicare outpatients if the patient was evaluated in the ER. Hope this helps some.
I'm assuming you are inquiring specifically about consulting providers in your question. The situation of the observation patient is addressed at the top of page 4 and it while it says that only the admitting provider may bill the initial observation care codes, it does not address whether or not consulting providers may bill the subsequent observation care codes. I would assume this means that they can, but not having direct experience with that situation, I am not sure whether or not specific payers or contracts might deny them for non-admitting providers as duplicate services. In the practice where I worked, we would have billed the outpatient codes 99212-99215 for all follow-up consulting physician services to Medicare outpatients in observation status.
I looked over your attachment and although it is correct for patients in observation, you've indicated 'outpatient' and I would just note that it is not quite correct for outpatient situations where the patient has not been admitted to observation status. In cases of outpatients not admitted to observation, 99224-99226 would not be appropriate for follow-up care, whether Medicare or non-Medicare, and consulting physicians should use 99212-99215. Also of note, in the case of initial consultations for Medicare patients, 99281-99285 would be used instead of 99201-99205 for Medicare outpatients if the patient was evaluated in the ER. Hope this helps some.
carelitz
Guest
Yes, that helps quite a bit! Thank you!