Subsequent visits in an outpatient facility setting

What is the proper code to use for subsequent physician visits when the patient is in an outpatient facility setting? Every year I hope and pray that they create a new set of codes that are applicable specifically for use with place of service 22, and every year I'm disappointed. I got a little excited when they, at least, created the new subsequent observation codes for 2011. Although the description of codes 99201-99205 and 99211-99215 specifically state "office or outpatient", we consistantly have insurance companies denying claims when these codes are used with place of service 22. Why is this such a problem, and is there anything we can do to avoid denials other than appealing claims and arguing with the insurance companies?

re: Subsequent visits in an outpatient facility setting

99211-99215 are what you need if you cant use a subs obsv code. I've never had a denial for one of these codes for POS 22...i think thats odd...I mean, look how many specialists see pt's in an outpatient clinic...what codes are they expected to use? Wierd!

re: Subsequent visits in an outpatient facility setting

I agree with you completely Lindalou, and it is exhausting to explain coding rationale to a CSR at the insurance company that has no coding knowledge whatsoever. We are in Michigan and can you believe that we have our Blue Care Network reps telling us to use 99218-99220/99224-99226 for outpatient visits when our physician is not the "admitting"? (So as not to start another discussion on the use of the term "admitting", in this case I am referring to the physician supervising the patient's observation stay).

re: Subsequent visits in an outpatient facility setting

What the insurers are missing is that by using for example, 99214 with place 22, they are entitled to pay less than place 11 since you have no office costs associated with the visit. There was just a CERT review that showed 90% of docs performing procedures in hospital outpatient setting were billing it with office place of service and that Medicare overpaid millions because of this and that this was going to be a big audit target.

We can't win with these guys!