Orthopedic Coding Alert

Second day of observation? Look to 99224-99226.

Though it is rare, your provider might elect to keep a patient in observation for more than two full calendar days. When this occurs, you'll code the "middle" day with subsequent observation codes.

According to Medicare, the decision whether to discharge a patient from the hospital or admit the patient as an inpatient can be made in less than 48 hours, usually in less than 24 hours, says Todd Thomas, CPC, CCS-P, president of ERcoder, Inc. in Edmond, Oklahoma.

An observation spanning more than two calendar days is infrequent. When, however, a patient is admitted to the hospital on day one for observation, stays all of day two, and is discharged on day three, you'll report one of the following codes for the second day:

• 99224, Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: problem focused interval history; problem focused examination; medical decision making that is straightforward or of low complexity...
• 99225,  ... an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity...
• 99226, ... a detailed interval history; a detailed examination; medical decision making of high complexity....

You only need to satisfy two of the three key components for each code level, says Thomas.

Warning: You might want to give your insurer a heads-up before sending in this claim. Often, payers request that you include documentation as to why the patient was in observation for so long without being admitted to the hospital.