Oncology & Hematology Coding Alert

Question: How should I report observation care codes if my physician admits a patient for a 23-hour observation to receive chemotherapy?

North Carolina Subscriber

Answer: When the patient remains in observation for at least eight hours and the oncologist discharges the patient on the same calendar day, you may use codes 99234-99236 (Observation or inpatient hospital care). That's because these codes represent care that lasts between eight and 23 hours.

For instance, if the oncologist admits the patient to observation on one day and discharges the patient the next, you may assign 99218-99220 (Initial observation care) with discharge code 99217 (Observation care discharge).

Suppose the physician admits a patient for observation to receive chemotherapy. In that case, the physician may bill for initial observation care (99218-99220) based on the level of service he provided. When the physician's decision to admit the patient began at another service site, such as the emergency department, all E/M services the supervising physician provides are part of the initial observation care.

Remember that you can't report any other E/M code when the oncologist discharges the patient on the same day that he admitted the patient to observation status. But if the physician discharges the patient on a day different from the day of admission, you may report 99217. This code includes all services provided on the date of discharge from "observation status," which includes final examination of the patient, discussion of the hospital stay, discharge instructions, and preparation of discharge records.