Cardiology Coding Alert

Soon you'll have initial, subsequent, and discharge options.

Last month's issue of Cardiology Coding Alert reported the addition of three new "subsequent observation care" codes.

Here are the definitions:

• 99224 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit
• 99225 -- ... An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity.
• Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit
• 99226 -- ... A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem.

Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.

Historically, patients admitted to observation status in a hospital were either discharged or admitted as an inpatient within 24 hours. Consequently, observation care codes recognized initial observation care (99218-99220), observation discharge (99217), or both services when provided on the same date (99234-99236).

Changes: In recent years and for multiple reasons, physicians might keep patients in observation status for multiple days (not just initial care and discharge days). CPT 2011 adds the three new codes for "subsequent observation care" to facilitate reporting physician services on those "in-between" dates.

Example: A cardiologist provides initial observation care to a patient on Tuesday, sees the patient again in observation on Wednesday, and discharges the patient to home on Thursday.

In this scenario, code the cardiologist's services as follows: One of the initial observation care codes (99218-99220) for Tuesday

One of the new subsequent observation care codes (99224-99226) for Wednesday

The discharge service code (99217) for Thursday.