ED Coding and Reimbursement Alert

Question: How should I report a patient's 23-hour stay in observation?


Virginia Subscriber
Answer: How you-ll report a 23-hour observation stay depends on when the patient was admitted and discharged. Most of the time, the admission occurs on the same calendar day as the emergency department service, which means you-ll report a code from the 99218-99220 series (Initial observation care). 

When the doctor discharges the patient the following day, you-ll report 99217 (Observation care discharge day management). Remember that this code includes all of the evaluations from that calendar day, as well as all the work required to discharge the patient.

Occasionally, the whole scenario does happen in one calendar day: The patient presents in the ED early in the day, the physician admits her to observation, and then discharges her before midnight. For these patients, you-ll choose a code from the 99234-99236 series (Observation or inpatient hospital care).

Hint: A -complete- history for observation care services (99218-99220 or 99234-99236) is a little different than it is in the ED. When reporting these codes, you need at least one element each of the patient's past, family and social history. Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems Inc., an ED coding and billing company in Stoneham, Mass.