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Click here for more sample CPC practice exam questions and answers with full rationale

Coding Subsequent Obvervation Care for Non-Admitting Physician

Good afternoon,
Per the CMS guidelines Chapter 12 30.6.8 only the admitting physician can bill initial observation care services as well as subsequent observation care services. Which set of codes should be applied to visits billed by physicians other than the admitting in the observation OP setting? Furthermore, on an observation discharge date, could an OP visit be billed for any other specialty and/or physician that visits on that DOS where the patient was discharged from observation care?
TIA

Medical Billing and Coding Forum

Medicare Risk Subsequent visits POS 22

We are a cardiology practice and are having stuggles with one of our Medicare Risk plans denying 99225 or 99226 visits. We have been instructed by our billing company that this plan has it’s own "rules" and they will only accept one subsequent visit code per day regardless of provider or diagnosis. We have been instructed to change our denied codes to office visit codes 99213 or 99214. I believe this advice to be incorrect. If Medicare Risk plans follow CMS guidelines then it would be inappropriate to change these codes in my opinion. I am curious if any other specialist office is struggling with billing for their services/visits on hospital outpatient/OBS codes? And, am I incorrect in thinking we should continue to bill these codes and appeal these denials? Any thoughts or experiences/suggestions on this topic will be very appreciated!

Medical Billing and Coding Forum

Initial vs. subsequent encounter

Sometimes we see patients from the ER for follow-up wound care. For example a patient got stitches and bandages at the ER for an arm laceration, then was seen by us a few days later for a wound check and bandage change. Is this a subsequent encounter since the patient initially got care at the ER for the injury? Our provider is not employed by or affiliated with the hospital if that makes a difference.

Medical Billing and Coding Forum

Pregnancies, First v. subsequent

So. If a patient has been pregnant twice… But the first pregnancy resulted in a miscarriage at say, 10 or 12 weeks…

Is the ‘second’ pregnancy considered a ‘first pregnancy’ (i.e. Z34.01), or a subsequent pregnancy (Z34.81), since the first
one wasn’t a ‘full’ pregnancy that resulted in a birth…

Pure logic would have me believe it’s the second pregnancy, technically, because she’s been pregnant twice, but… Here I’ve gone
and started getting philosophical, so… Anybody have any concrete knowledge on this?

Thanks in advance!

Medical Billing and Coding Forum

Wiki subsequent orthopedic inpatient visits, i. 99231, 99232

I am an orthopedic coder needing some clarification. A patient is initially seen in the ED with a femoral neck fracture and the ED provider is requesting Ortho consultation; a hospitalist accepts them as an admit. The Ortho provider consults and determines that the patient needs to be taken to the OR for a hemi/total arthroplasty, he also reviews labs done and reports patients INR is too high to safely take patient to surgery. The Ortho provider see’s the patient for another 3 subsequent inpatient visits monitoring the patients INR and providing Vitamin K and managing this patient with another hospitalist/cardiologist in consultation as well. Can we bill those subsequent visits after the decision for surgery was made on his initial consultation? If the orthopedic provider was not providing any care regarding his INR except for coming in to the patients room and reviewing labs and the patient, would we be able to in that circumstance? We don’t do much inpatient visits in Orthopedics so I cant say Im definitively comfortable in this situation.

thanks for the help in advance

Medical Billing and Coding Forum

Billing 99211 for subsequent wound care sessions

Before anything else, THANK YOU for your kind attention & hopefully you could respond to my dilemma.

According to the CPT manual, a 99211 is an office or other outpatient visit “that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services.” Unlike the rest of the office visit codes, 99211 does not have any documentation requirements for the history, physical exam or complexity of medical decision making. The nature of the presenting problem need be only “minimal,” such as monthly B-12 injections, suture removal, dressing changes, allergy injections with observation by a nurse, and peak flow meter instruction. (For more examples, see Appendix D of the CPT manual.)

Scenario. In our outpatient hospital wound care setting, the subsequent wound care sessions consist of wound care dressing changes by the RN usually 20 sq cm area of wound, ankle brachial pressure index readings by the RN for 15 minutes, and a referral back to the surgeon for his advice/opinion on the case. The surgeon (MD) signs off on the clinical documentation of the encounter. The entire session lasts no less than 25 minutes, and on average 30 minutes. Will still be considered a 99211 billing?

Please advise.

Thank you again.

Medical Billing and Coding Forum

NP Subsequent Hosp Visits? and Discharge?

INPATIENT setting
NP Is part of our private practice (NOT a Hosp NP) (Our MD has privileges at hosp not employed by them)
I know she can see PT as consults at hospital. However, I once was told that I cannot bill for subsequent visits.
I am looking for info input or documentation-
-Our NP sees patient on Subsequent visits in the hospital, can she get paid for this? …if only she sees the PT?
I bill for Illinois and Missouri. Please advise, thanks, Kimber

Medical Billing and Coding Forum