Subsequent Observation Care

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Subsequent Observation Care

Postby Thestephcode » Wed Feb 14, 2018 6:00 pm

Chapter 12, Section 30.6.8.A of the Medicare Claims Processing Manual indicates that the Centers for Medicare & Medicaid Services (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.

Can a provider bill for subsequent observation services if they did not order it?
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Re: Subsequent Observation Care

Postby admin » Thu Feb 15, 2018 2:09 pm

Good Morning-

The provider who did not place the order for observation will bill the outpatient codes for the initial day they see them and the subsequent days if care continues. For the initial DOS they see the patient they would code new (99201-99205) or established E/M (99211-99215) depending on whether or not that patient is established with them or their practice. The subsequent DOS would then be coded as an established E/M code 99211-99215.

This is an explanation from CMS:
For patients receiving hospital outpatient observation services who are not subsequently admitted to the hospital as inpatients, physicians should report CPT codes 99217-99220. In the event another physician evaluation is necessary, the physician who provides the additional evaluation bills the office or other outpatient visit codes when they provide services to the patient.
• For example, if an internist orders observation services, furnishes the initial evaluation, 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 patient office or other outpatient visit codes as appropriate. ... mm6740.pdf

Your question has been answered by Stephanie Allard, CPC, CEMA, RHIT
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