Kathy k Posted Wed 08th of February, 2017 12:52:16 PM
Our hospitalist saw a patient in observation for the initial visit and billed a 99219. Another physician from a different specialty/TIN discharged the patient on the same day.
Medicare is denying our 99219-initial because the other physician's bill processed before ours and paid their 99217-discharge code.
Could I appeal the way Medicare processed this? It doesn't seem right for them to pay for a discharge but not an initial visit. Is there another way I should be coding the initial OBS visit so it doesn't bill against the same day discharge?
SuperCoder Answered Thu 09th of February, 2017 02:20:40 AM
To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate]. Thank you.
Kathy k Posted Thu 09th of February, 2017 12:48:52 PM
I understand that. BUT the admit for observation was from a Hospitalist and the discharge (on the same day) was from a different provider/group. Do I still code 99234-99236 even though they were two different provider's from different group practices?
SuperCoder Answered Fri 10th of February, 2017 03:24:17 AM
There are few points that are kept in mind before billing Observation or Inpatient Hospital Care Services (Including Admission and Discharge Services on same day):
- Documentation stating the stay for hospital treatment or observation care status involves 8 hours but less than 24 hours;
- Documentation identifying the billing physician was present and personally performed the services;
- Documentation identifying the admission and discharge notes were written by the billing physician;
The code selection in above scenario is wrong. For "observation status" or "inpatient status" admission and discharged on the same date, code selection will be from range 99234-99236. However, admission and discharge has to be from same billing physician/same tin.
Correct coding with supporting documentation will help to recoup.
Also, if one hospitalist admits the patient at 1 am and another hospitalist discharges them at noon. Since both hospitalists are part of the same group and specialty, they function as one physician. Only one physician should report the bundled care code 99234-99236 if documentation from both physicians supports their use with two face-to-face encounters separated by 8 hours. Admitting physician gets the credit for the bundled code. Hope it helps.
Kathy k Posted Tue 14th of February, 2017 19:19:57 PM
In this scenario.... Our hospitalist was the admitting provider to Observation status. The discharging provider (on the same day) is from a DIFFERENT billing physician/TIN.
How do we code this correctly?
SuperCoder Answered Thu 16th of February, 2017 13:15:21 PM
There are no set guidelines for such scenario. Since the admitting and discharging providers are from different TIN, they will have to send addendem, along with the patient report stating admitting and discharge providers are from different speciality/TIN, so that insurence company pays accordingly. (depends on payer to payer) However, code range will be 99234-99236 only.