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Subsequent visit

Annie Posted Fri 22nd of September, 2017 15:46:56 PM
What are the correct codes to use for Medicare subsequent observation visit? For example 99201 (I), 99224(S) or would it be 99201, 99212.
SuperCoder Answered Mon 25th of September, 2017 04:47:57 AM

Subsequent observation visit series is 99224-99226, it can be billed when initial observation visit has been billed from the series 99218-99220. CPT 99201 is office visit code, for subsequent visit CPT 99224 not to be coded with office visit, if patient visited again to the same department then use 99211-99215 series code as established outpatient visit.

Annie Posted Mon 25th of September, 2017 09:08:55 AM
Does this pertain to observation services in the hospital? For example patient has Medicare and is admitted for observation. We use 99203 if they have never seen that provider before and 99213 if they are a establish patient. If they stay two more nights(subsequent visit) what would we use 99224 or 99213?
SuperCoder Answered Tue 26th of September, 2017 04:27:01 AM

The observation codes are used to report evaluation and management services provided to patients designated/admitted as "observation status" in a hospital. It is not necessary that the patient be located in an observation area designated by the hospital. If such an area does exist in a hospital (as a separate unit in the hospital, in the emergency department, etc.), these codes are to be utilized if the patient is placed in such an area. If patient is admitted in observation unit, then use the code out of 99218-99220 series for initial observation care, then overnight stay (subsequent visits) can be billed by using code(s) out of 99224-99226 series as subsequent observation care, then CPT 99217 observation care discharge. Code series 99201-99205 and 99211-99215 are for office/out-patient visit for new and established patient respectively, hence these codes not to be used for the patients who admitted in observation unit.

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