tci E/M Coding Alert - 2019 Issue Q3

Reader Question: Observe These Rules, Report Subsequent Care With Ease

Question: Our pulmonologist was called in to the hospital by the admitting doctor as a specialist to evaluate a patient in observation. We billed subsequent observation code 99226 for our doctor’s services, but Humana denied the claim, stating that the service we reported “exceeds the maximum number allowed per day” because another subsequent observation service was billed on the same date of service by a different provider (the admitting physician) for the same patient. Is there a different code we should for a subsequent observation specialist visit if another physician already billed code 99226? Oregon Subscriber Answer: ...

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