tci Part B Insider - 2011 Issue 24

Reader Question: Are 2 Separate E/M Visits at 2 Locations Both Billable?

Question: We saw a patient in the office and then sent her to the hospital for observation. We billed an office visit (99214) and billed observation care (99219) for the same date of service. Our MAC paid both, but now is asking for a refund for the office visit. Should we appeal or send the payment back?Answer: It sounds as if your MAC is correct. In your situation, you should report only the observation care and not the office visit.In black and white: Per CPT, "When 'observation status' is initiated in the course of an encounter in...

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