General Surgery Coding Alert

Question: My physician admitted a female patient for observation with left lower quadrant abdominal pain, suspicion of small bowel obstruction. The first day (Jan. 22) was billed as an initial observation day, and a discharge observation day was billed Jan. 24. According to the hospital, the patient was kept in observation all three days. How should we bill the second day (Jan. 23)?

Colorado Subscriber

Answer: CPT does not contain subsequent day observation codes, probably because patients are rarely kept in observation very long.

Because a patient in observation at a hospital is considered an outpatient, the appropriate established patient visit code (9921x) should be billed for the second day. As noted, the first day is billed 99218-99220 (initial observation care), depending on the level of E/M service provided, and 99217 (observation care discharge) is appropriate for the discharge from observation.