Hospital Observation with Prolonged Care.

Has anyone else had trouble billing "outpatient hospital observation" care in addition to "prolonged time"? According to CPT® as of 2012, codes 99356 and 99357 are to be billed in conjunction with CPT® 99220 (we used to bill 99354 & 99355 but these can no longer be billed with 99220).

MEDICARE PATIENT: We tried billing 99220 as the primary with prolonged code 99354--this was denied as: "missing related or qualifying service". According to CPT® 2012 and forward, 99356 is to be biled with 99220. Only problem is, when we bill them together, 99356 & 99357 get denied as "inconsistent with place of service". Found out that Medicare does not have these codes set up as "companion codes".

Maybe we are billing this incorrectly. Here is the scenario: We are a clinic and out doctors see patients at the hospital. A patient was brought to hospital. Decided patient would be handled as "observation care". Physician initially spent 75 minutes with the patient. The physician was called back in later that evening, spent an additional 80 minutes on the same day.

We billed this out as 99220, 99356, and 99357 as place of service 22 (outpatient). Medicare is covering the 99220 but denying the other 2 codes as "procedure code/bill type is inconsistent with the place of service".

Any suggestions? Are we billing this correctly?

Thank you for any input that can be given.

re: Hospital Observation with Prolonged Care.

Did you read this? http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM5972.pdf CMS does not recognize prolonged services with Observation.

It is clinically unlikely that a patient on Observation needs 1:1 MD care like that. if so, they would be an inpatient.