Ophthalmology and Optometry Coding Alert

Question: The ophthalmologist arrives at the hospital at 8 p.m. Wednesday to evaluate an established patient with double and blurred vision, and symptoms of dehydration. They order observation care, and the hospital places the patient in an outpatient observation bed. The doctor documents an extended history of present illness (HPI), detailed review of systems (ROS), complete past/family/ social history (PFSH), and comprehensive physical exam. Medical decision making (MDM) is of low complexity. After receiving several rounds of fluids, the ophthalmologist discharges the patient at 7 a.m. Thursday. How should I report this encounter?

Vermont Subscriber

Answer: In this case, the observation care lasted two calendar days, so you should report a pair of observation codes. On the claim, use 99218 (Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity) for the first day of observation and 99217 (Observation care discharge day management …) for the second day of observation.

Reasoning: The first day of care represents services that line up with 99218. If the patient comes in as observation care on one calendar date and is discharged the following day, the physician may be able to report 99217 for the second date.

Keep in mind, however, that 99217 requires evidence of a face-to-face encounter between provider and patient. Without a face-to-face visit on the discharge date, you’ll probably have to leave 99217 off the claim.

Do this in 2023: You will have to switch up how you bill for these services next year. Starting Jan. 1, 2023, you’ll no longer be able to use 99217-99220 for outpatient hospital observation status. CPT^® 2023 will streamline reporting by providing one set of codes that encompasses both inpatient and observation services.

Instead of 99218, you will use code 99221 (Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/ or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.) for observation services provided on day one. Note the original descriptor has been overhauled to be more inclusive of observation care.

Expect a change in reporting discharge services as well. Come January, you’ll scrap 99217 and look to the following codes — whose descriptors have also been revamped — for hospital inpatient and observation discharge day management.

• 99238 (Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter)
• 99239 (… more than 30 minutes on the date of the encounter)

Pro tip: Make sure the provider documents the amount of floor time spent doing the discharge.