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Subsequent Observation Code for consulting physician?

Kelly Posted Wed 07th of September, 2011 21:02:17 PM

Physican was consulted on a patient that was observation status and coded a '99253'. The patient is PA Medicare so we cannot bill a consult code. Would it be correct to assume that we could bill a subsequent observation code '99224'-'99226' even thought it is still the first day the patient is being seen, in other words another physician already billed as the attending and used the initial obv code '99220' on the same day? Or should we code an outpatient office visit '99213'-'99215'?

SuperCoder Answered Thu 08th of September, 2011 04:00:57 AM

The POS for Observation is 22, being considered as outpatient. I believe the consultation provided on outpatient basis should be coded as 99243(not 99253). In case of a follow-up consultation, you would code 99212-99215.

Now, the question comes to subsequent observation codes: According to CPT 2011, subsequent Observation care codes can be reported by both the attending physician of record and specialists who provide medically necessary, nonoverlapping care to patients on any day other than the admission or discharge day.

The additional related info is in a tabular format with me, which can't be sent as it is. If you contact me on my email id (, I will be able to reply.

Emily Answered Thu 08th of September, 2011 04:02:49 AM

MCR will not pay twice in a day for 99220. If patient is new and has not been seen in the past 3 years, you can use outpatient codes for new pts 9920x series. If established, 99213 to 99215.

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