Wiki Observation consultation/Hospitalist- professional billing

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chrissym67

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Hospitalist (A) completes a consult for a surgeon on a “new” patient in observation status. The next day, a different Hospitalists (B) in the same group see's the same patient still under observation for a subsequent visit. I have narrowed it down to a EPF history and exam and straightforward medical decision making.

How do I code these two days for these two Hospitalists?
I coded the initial consult as 99202 (pos 22 - outpt) for Doc A and 99224 for the subsequent visit - also pos 22 for Doc B. I'm being told this is not correct and to use "observation consult codes". Most insurance co's don't accept the consult codes anymore. According to all the information I can find online - the codes I used are correct. Could someone please verify :confused:
 
If the insurance carrier pays for consults, look at codes 99241-99245 for your initial encounter. If they do not pay for consults, look at codes 99218-99220 instead. Your second day looks correct. Review the info in your CPT book under "Initial Observation Care" to see if that will help clarify.
 
I did. Wouldn't the surgeon be coding for the initial obs codes 99218 - 99220 as the "supervising physician" initiating "observation status" as stated in the CPT book. Can both the surgeon and the Hospitalist both code in this range of 99218-99220? The Hospitalist is billing it as a consult.:confused:
 
Everything I have looked at tells me the admitting physician uses the initial observation code and the other physicians use the regular office visit codes. For the subsequent encounter you use the subsequent for all providers.
If you look in your CPT book at the section for Observation codes in the instructions the first paragraph states:
The following codes are used ... by the supervising physician.....
For observation encounters by other physicians see office or other outpatient consultation or subsequent observation codes as appropriate.
From the instructions provided you have it coded correctly.
 
I agree wtih Debra; I erroneously assumed the hospitalist was doing the admission for the surgeon.
 
See the Medicare Claims Processing Manual Chapter 12 Section 30.6.8. This should answser all your questions as they provide some good scenarios.
 
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