CPT® 99219 help!!

Hello there,
I'm new at the orthopedic specialty... I am having such a hard time with the CPT® code 99219, it gets denied! Our provider charges it every time he does a procedure/surgery at the hospital. Could someone tell me when is not appropiate and when it is to bill this observation code?

Any help will be greatly appreciate! Thanks!

Alba

re: CPT® 99219 HELP!!

Typically only the attending or supervising physician can charge observation care (99218-99220).

If a specialist is being called in for an opinion, and its Medicare which does not pay for consults, then in the observation setting the correct coding is either new (99201-99205) or established (99212-99215) based on whether the patient is new or established (three-year rule) to your provider.

I'm assuming in this case that ortho is not the attending/admitting doctor.

If he or she is, then the observation codes are appropriate and denials could happen. If this visit is the day of the surgery, the E/M is bundled into the surgery unless it is for a separate reason (modifier 25) or decision for surgery (57).