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Two physician saw same patient on 1st day in OBS

SuperCoder Posted Tue 07th of May, 2013 17:55:59 PM

I need to know how to code for an OBS stay for our doctor when he was asked to see a patient by the admitting physician on the same day. This is a Medicare patient. "99220" was denied. Thanks

SuperCoder Answered Tue 07th of May, 2013 21:26:56 PM

We are working on this.


SuperCoder Answered Wed 08th of May, 2013 07:08:07 AM

Two E/M visits on same day by 2 physicians from same specialty is not permissible. If your doctor is from the same specialty as the admitting physician, then only 1 physician could bill the visits. In this case, combine the components/findings of 2 visits and bill a single visit.

This applies for initial or subsequent hospital observation service OR for inpatient visit OR for physician office visit.

If your doctor has a different specialty than the admitting doctor, then the separate visit can be coded separately, either as a consultation or as an initial visit, based on type of visit.

SuperCoder Posted Wed 08th of May, 2013 15:37:15 PM

Thanks The admitting phyisican is PCP and my doctor is Gastro. I coded the OBS as 99220 and so did the PCP. My claim was denied by Medicare. Because this is OBS AI modifier can not be used. I need to know do I code my claim with 99204? Or some other E/M code? Thanks.

SuperCoder Answered Thu 09th of May, 2013 06:50:03 AM

If AI modifier cannot be used with admitting physician's code, then for Gastro physician's billing, use subsequent Obs. E/M code (99224-99226). That is OK to do. As per CPT manual instruction,

"For observation encounters by other physicians, see office or other outpatient consultation codes (99241-99245) or subsequent observation care codes (99224-99226) as appropriate."

Since the visit is in Obs. setup, you should not bill 99204.

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