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Inpatient Facility Coding & Compliance Alert

Reader Question:

Yes, You Can Bill for Back-to-Back Observation and Subsequent Care - Sometimes

Published on Fri Dec 21, 2012

Question: A patient was admitted to outpatient observation and remained there for two days. On day three, her status was changed to inpatient admission (where she remained through her C-section delivery and discharge). The Colorado Medicaid system does not allow for an outpatient visit within 24 hours of an admission. How do I bill for the patient’s six days of care, considering her two different status circumstances?

Colorado Subscriber Answer: You’ll need to report several different codes to explain the situation as her time in the hospital progressed. Day 1: Bill the appropriate observation care code from the range 99218-99220 (Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components …). Day 2: Bill the appropriate subsequent observation code from the range 99224-99226 (Subsequent observation care, per day, for the evaluation and management of a patient, which [...]
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