consult in observation status

When billing for a hosptial consult and the patient is in observation status, not inpatient, and the insurance doesn't accept the consult codes, do you bill an observation code or a new or established patient E & M code?

Thank you.

re: consult in observation status

New or established E/M code

re: consult in observation status

I agree, this is how we do it, but I am confused by the guidelines in the CPT® book. it says "For observation encounters by other physicians see...99241-99245 or subsequent observation care codes (99224-99226) as appropriate".

How would you interpret that?

re: consult in observation status

CPT® does not set reimbursement rules. Each payer does.

re: consult in observation status

Download the chart "Category of Code" from the Codapedia entry entitled Category of Code for an easy cheat sheet.

re: consult in observation status

I can't seem to find this, would you point me in the right direction? Thanks

re: consult in observation status

The codes you refer to (99201-99215) are for office or other outpatient services. These codes are further based on whether the patient is new (99201-99205) or established (99211-99215). (A new patient is defined as one who has not been seen by you or anyone within your group and your same specialty in the last three years.) Use these codes for Medicare patients— as long as neither you nor anyone in your group admitted the patient to observation, but have been subsequently asked to participate in that patient's care.

For private carriers that have not followed Medicare's example and eliminated consult codes, you can still use outpatient consultation codes (99241-99245), if your opinion was sought during a patient's care.

re: consult in observation status

I'm sorry, I didn't clarify. I was looking for the chart "category of code" cheat sheet that was referenced. I tried looking for it and can't find it. Thank you.