ED Coding and Reimbursement Alert

Question: Our physician was one of the doctors who saw a patient in observation care in the hospital, and then he saw her on the day she was discharged. We reported 99217 for our doctor's work providing the observation discharge and Medicare denied it. How can we appeal?

Codify Subscriber

Answer: Before you appeal, first ensure that you meet the requirements to report 99217 (Observation care discharge day management...). This code is so mired in confusion that it was approved earlier this year as an open audit issue by the Recovery Audit Contractor for Region A, which means that audits for this code are going to increase dramatically in the near future.

"Only one hospital discharge day management service is payable per patient per hospital stay," the RAC said in its announcement that it would be auditing this code. "Only the attending physician of record reports the discharge day management code."

What this means: In the case in question, it's likely that your ED doctor billed for the observation discharge and the attending did as well, which means his was paid and yours was denied. If your physician isn't the attending doctor during the patient's observation stay, you should only report E/M codes for your doctor's visit with the patient on the date of her discharge.