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99220 Observation

Carlos Posted Thu 06th of December, 2018 11:23:37 AM
We received a denial from Humana for CPT 99220 because another physician already billed for this code the day prior to our date of service I am assuming it was already billed by the admitting doctor. Our physician is specialist and was called to do a consultation on the patient while he was till in observation. Which CPT code should we use?
SuperCoder Answered Fri 07th of December, 2018 02:29:48 AM

Hi Carlos,


Thank you for your Question.

For Medicare patients, If the specialist is consulted for patient who is in observation status, the surgeon should report new patient (99201–99205) or established patient (99211–99215) office/outpatient codes.

For non-Medicare patients, if the consultation is done after the patient is admitted to the hospital, consultation services in observation status are reported with the outpatient consultation codes (99241–99245).

Hope this helps!

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