Wiki Observation place of service - I have a bill from a provider

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I have a bill from a provider that treated the patient that was initially seen in the emergency room, and was subsequently admitted to ETU for observation for 24 hours. The physician is billing the place of service as "22" and the E/M code 99213. I am questioning the appropriateness of both if someone could offer their opinion. Thank you.
 
observation

obeservation for our carriers is consider outpatient hospital as the patient has not been admitted to the inpatient status. So we use the outpatient place of service code.

also there are observation codes (99218-99226, and the observation discharge codes99217 that you would use, not the 99213.
 
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Only admitting doctor may use those Observation codes you pointed out. Outpatient codes are appropriate however we are having such a hard time with prior auth issues because of the POS 22. UHC states Observation status does not require auth but when we bill the observation as POS 22 they deny us for no auth as outpatient. What are we to do? I have a list of in hospital procedures that have been denied from especially UHC because of this.
 
observational codes

My understanding is observational codes 99224,99225,99226 are the subsequent codes with pos 22 and can be used by admitting and consulting MD, except Medicare does not accept these codes they stilll us to use new or established oupt codes like 99213

Only the admiting doctor can use 99218 -99220 initial only
99217 discharge

We all seem to have a different opionion. look at the aapc feb 2011 they have a nice article in there regarding observational codes.
 
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CPT code 97607 for Wound Care

My hospital is billing this code on a 1500 claim form with POS 22 but Medicare is denying stating the POS in incorrect. Since this is an outpatient hospital the 22 POS should be correct. Does anyone have any idea's since CCI edit shows this as a payable code.

Thanks.
 
Medicare Place of Service denials

Medicare has recently added POS 19 Off-Campus Outpatient Hospital / A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. Would your facility fall under this catagory? Also if the faciity bills a claim separate from the physician this needs to match.
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Thank you,
Tammy May CPC
 
634sg4fs65g4fg said:
Only admitting doctor may use those Observation codes you pointed out. Outpatient codes are appropriate however we are having such a hard time with prior auth issues because of the POS 22. UHC states Observation status does not require auth but when we bill the observation as POS 22 they deny us for no auth as outpatient. What are we to do? I have a list of in hospital procedures that have been denied from especially UHC because of this.
Click to expand...

We are experiencing this same problem still in 2017. We had to reach out to our Provider Rep for our region in order to get these paid, after exhausting all reconsiderations. Its the only way unfortunately. We are to usr Out PT POS for Observation and Out Pt E&M and sub hospital codes for following days.
 
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