Cardiology Coding Alert

Question: Please explain the difference between a 23-hour stay and observation. We now use 23-hour stay for patients that need a cardiac catheterization and cannot stay as an inpatient but need to stay overnight. When then would one use an observation? How would an admit and discharge be done for this type of procedure? Is 23-hour stay just jargon for HMO insurance companies that will not permit 24 hour stay or longer?

Illinois Subscriber

Answer: A 23-hour stay, or short stay, as some hospitals call it, typically means the patient is brought in to the hospital for an elective procedure and then is admitted either to outpatient or observation status, says Terry Fletcher, BS, CPC, CCS-P, a coding and reimbursement specialist in Laguna Beach, Calif. The issue here is that you cant bill for this time or history and physical (H&P) because you already were paid for it in the office setting. Heart caths, interventions, etc., have a 24-hour global period on them, and unless you pick up the patient in the hospital for an acute onset, then only the procedure can be billed.

If the patient is admitted to observation over more than one calendar date, you can use codes 99218 through 99220 (initial observation care, per day, for the evaluation and management of a patient) and discharge code 99217 (observation care discharge day management).