Forum - Questions & Answers

Jul 15th, 2014 - cmc2012 14 

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!


Jul 15th, 2014 - CodapediaMsgBoard 96 

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).

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