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Can you bill Office E/M Codes for subsequent observation visits?

Sadna Posted Fri 08th of November, 2019 13:11:28 PM
Patient was admitted to observation on 11/01/19 we are billing with CPT 99220 - POS 22. The next two days 11/02/19 and 11/03/19, the patient stayed in observation. Can these days be billed with POS 22 and CPT 99211 through 99215 office E/M codes? We have found that subsequent observation CPT 99224 and 99225 are often not paid by insurance companies as they are not found in their fee schedule.
SuperCoder Answered Mon 11th of November, 2019 06:42:36 AM

Hello Sadna,

Thank you for your question.


As per the above documentation, the patient was admitted on 11/01/19, for which CPT® code 99220 was reported in place of service (POS-22).

If a patient is held in observation status for more than two calendar dates (11/02/19 and 11/03/19), then the ordering physician should utilize a subsequent observation care CPT® codes (99224-99226).


Note: If the provider who performed the initial observation care, also renders the subsequent care, then he should bill the initial and subsequent observation care codes. The other physician who evaluates the patient in subsequent day(s) in observation care; they can bill outpatient visit codes as appropriate.


Hope that helps!


Sadna Posted Wed 20th of November, 2019 17:05:52 PM
So the other physician should bill new patient visit codes 99201-99205 or would he use established visit codes 99211-99215 and will the POS code be 22?
SuperCoder Answered Thu 21st of November, 2019 05:52:43 AM
Hello Sadna Thank you for your question nbsp All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes nbsp When a specialist is called in to see a patient in observation that service...

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