ED Coding and Reimbursement Alert

Code service only when making admittance decision to prevent denials. Although CPT offers two observation code sets, and encounters that look like observations may actually be other E/M services, your observation coding can be spoton every time simply by following this five-step plan. Step 1: Confirm Type of E/M Service Before coding, be sure that the service qualifies as an observation. -Observation is a hospital-based outpatient service used to determine if a patient needs inpatient care. Most payers limit the time a patient may be in observation status to 23 hours, though some (Georgia Medicaid, for example) allow as long as 48 hours,- explains Jeffrey Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance at Emergency Pediatric Group Children's Healthcare of Atlanta at Egleston. So when you-re reviewing the notes, ensure claim correctness by checking the encounter specifics against Linzer's observation definition. Observation: A patient reports to the ED [...]