Wiki Observation Codes

[nantes1993]

Patient admitted to observation on 8/5/15 using code 99218.
Another provider was asked to provide a consult on 8/6/15 which that provider billed a 99226. Patient was discharged later on 8/6/15 in which 99217 was billed.
Denial is stating the 99217 and 99226 are incidental and are not payable in this situation.
What other way can this be billed?
Thank you.

 

[mitchellde]

The consult was billed incorrectly. It should be billed using regular OV codes with outpatient POS. Only the provider that admits the patient to observation can use observation codes.

 

[swilkie]

Yes, Debra is correct with this instance. Please look up MLN Matters MM6740 Revisions to Consultation Services Payment Policy. Page 4 (first bullet) explains the logic for billing Observation services for consultants.

 

[bedforak1]

Agree. The 99226 was billed incorrectly. That provider will need to bill 99201-99205 if it's a new patient or 99211-99215 if he or she has seen the patient before.