Wiki observation coding - correct procedure

[sky]

there is quite a discussion regarding the obs coding - some people seem to think that it is being billed out incorrectly. what is the correct procedure for this? p.o.s. is 22? what is the cpt code for the consult and/or dr. visit? i guess some of our pts are getting stmts questioning the charges. they see ' out pt office visit' & call to say they were never in our office. i'm tired of the questions & would like something to show to them other than the cpt book. thanks for your help

 

[mitchellde]

I f you are the admitting physician for observation you use the observation codes for admission and subsequent with POS 22 if you are are consulted in to see the patient in obs you use the 99201-99215 with POS 22. Look in the revised CMS manual for information on this.

 

[hewitt]

Please see page 18 of this CMS document. https://www.cms.gov/manuals/Downloads/bp102c06.pdf
To quote BCBS, "Observation services are defined as the use of a bed and periodic monitoring and/or short term treatment by a hospital's nursing or other staff. These services are considered reasonable and necessary to evaluate a patient's condition to determine the need for possible inpatient admission. Observation care provides a method of evaluation and treatment as an alternative to inpatient hospitalization." You may have to piece together snip-its from a few sources to come up with a competent handout. Hope this helps! Good luck!