Pamela Posted 1 month(s) ago
I recently read an article in the RACmonitor (12/7/2017) by Ronald Hirsch, MD, FACP, CHCQM, [i]Physician Billing for Observation: If you Don't Order it, You Can't Bill for It[/i]. In it he stated CMS Processing Manual states CMS will “pay for initial observation care billed by only the physician who ordered hospital outpatient observation services and was responsible for the patient during his/her observation care”. Does this mean that a physician from a group practice that writes an admission order in the middle of the night must be the one who does the face-to-face visit with the patient in order to bill the observation code? And, his partners in the group can’t see the patient and charge subsequent observation codes? For example, we have a group of employed hospitalists that are basically considered the same “physician” for billing purposes. When Doctor A (from the hospitalist group) is on call and admits a patient to observation via telephone at 200 a.m., the following day Dr. B (from the same hospitalist group) is on call and goes to see the patient face-to-face for the first time and bills the initial Observation code (99218-99220). Other hospitalists in the group may see the patient during the stay and bill subsequent Observation codes (992224-99226) or discharge code (99217). Can you help clear up this conundrum?
SuperCoder Posted 1 month(s) ago
Greetings from SuperCoder!
Visit should be face-to-face to bill the observation code. If Dr. A admits a patient to observation via telephone at 200 a.m., then Dr. A needs to see that patient face-to-face and complete the documentation. On the other hand, if Dr. B goes to see the patient face-to-face for the first time and prepares documentation, then Dr. B should bill initial Observation code.
Please feel free to write if you have any question.
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