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99226 SUBSEQUENT OBSERVATION CARE

Carlos Posted Tue 26th of February, 2019 17:40:41 PM
Humana claim denied stating the service exceeds the maximum number allowed per day because another subsequent observation service was billed on the same DOS by a different provider for the same patient. We are specialist and our physician was called by admitting to see this patient as specialist. Which CPT code can we use for subsequent observation specialist visit if another physician already billed for CPT code 99226?
SuperCoder Answered Wed 27th of February, 2019 03:48:21 AM

Hi Carlos,

 

Thanks for your question.

 

Code 99226 cannot be reported more than once per day. Initial and subsequent observation care codes can only be billed by the admitting doctor.

 

The other doctors who evaluate the patient must bill the consultations, new or established office visits, or other outpatient visit codes as appropriate.

 

Since your doctor was called by the admitting doctor to evaluate the patient in observation, you should bill the consultations, new or established office visits, or other outpatient visit codes.

 

Please feel free to write if you have any question.

 

Thanks

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