Neurosurgery Coding Alert

Question: We kept a patient in the hospital overnight for observation and decided the next morning that surgery was not necessary. Should I report 9923x and discharge code 99217, even though within the hospital this stay remains outpatient?

North Dakota Subscriber Answer: If a patient stays overnight (past midnight) in observation, you cannot report same-date observation/hospital admission and discharge codes 99234-99236. Instead, you must report the appropriate code for "hospital observation, initial observation care" from the 99218-99220 range on the day the patient was admitted. You would also report 99217 (Observation care discharge day management) on the day the patient is discharged, as you suspected.

Tip: You should only report 99234-99236 when the physician admits and discharges a patient on the same day (which includes those who undergo a complete workup and then expire). As soon as you realize that code choice is based on calendar day and not on a 23-hour time period, you'll overcome the urge to report those codes.