Cardiology Coding Alert

Although coding for observation can be frustrating because of differing hospital, Medicare and private payer requirements, following some relatively simple guidelines should make the exercise less confusing and decrease the number of denials.

Observation Definition and Codes

According to CPT, when a patient is in observation status, the attending physician supervises the persons care and performs periodic reassessments. In other words, observation is a kind of halfway house for patients whose physicians are uncertain whether individuals should remain in hospital or be sent home. The purpose of observation is to hold the patient until the physician has enough information to determine whether admission is warranted. For example, a patient who arrives in the emergency room (ER) with ill-defined chest pain may be placed in observation by the cardiologist until the cause of the pain can be ascertained. A person also may require observation after a procedure or test if complications arise or a separate problem presents itself that the physician believes merits closer scrutiny.

CPT lists seven observation codes that are broken down into two categories:

1. for patients admitted to and discharged from observation on different calendar days, and

2. for patients admitted and discharged from observation or inpatient on the same calendar day.

For same-day observation or inpatient admittal and discharge, the following codes are used for both new and established patients and are determined by the appropriate level of service supported by documentation:

99234 (new or established patient admitted and discharged to observation status on same date of service requiring detailed history, detailed exam, and medical decision-making of straightforward or low complexity).

99235 (comprehensive history, comprehensive exam, and medical decision-making of moderate complexity).

99236 (comprehensive history, comprehensive exam, and medical decision-making of high complexity).

If, for example, a patient presents to the ER with chest pain and is admitted to observation in the morning and discharged late that night (during the same calendar day), cardiologist should use one of the above codes, depending on the level of service provided that is supported by the medical documentation.

For patients admitted to observation on one date of service and discharged on another, the following codes should be used by the admitting physician only:

99218 (new or established patient admitted to observation status on one date of service and discharged on a different date of service, per day, requiring a detailed history, detailed exam, and medical decision making of straightforward or low complexity).

99219 (comprehensive history, comprehensive exam, and medical decision making of moderate complexity).

99220 (comprehensive history, comprehensive exam, and medical decision making of high complexity).

99217 (observation care discharge day management). This is used to bill for a discharge from observation that takes place on a [...]