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Eleen Posted 1 Year(s) ago
Hello, I have a question about coding an Observation Consult. Patient has Blue Cross Blue Shield insurance. Physician states it is a Consult, patient is in Observation Status. However, documentation does not support a consult. What would be billed if he is not the admitting physician in this case? Thank you!
SuperCoder Posted 1 Year(s) ago

OUTPATIENT CONSULTATION DURING OBSERVATION CARE:-

Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began. 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.
For example, if an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial observation care code. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate.
Ref: https://www.cms.gov/manuals/downloads/clm104c12.pdf
 

Hope that helps!

Posted by Eleen, 1 Year(s). There are 2 posts. The latest reply is from SuperCoder.

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