Otolaryngology Coding Alert

When an otolaryngologist admits a patient to observation status, keeping the numerous E/M codes straight requires more than a watchful eye. Consider the following scenarios to avoid incorrectly reporting the physician's services, which could result in undercharging or even double-dipping. 1. Same-Day Admission and Discharge Prior to CPT's creation in 1998 of observation care services (99234-99236), physicians had no way of charging for both a same-day admission and discharge. CPT allows only one E/M (code) per day, so carriers would pay for the admission service only and not the discharge service.

Now, instead of using the initial observation care codes (99218-99220) in conjunction with a separate discharge code (99217), physicians have the same-day admission and discharge codes (99234-99236) as an option. Although CPT does not require a minimum length of stay as a factor in reporting 99234-99236, Medicare has a minimum time requirement. For all non-Medicare payers, when a physician admits a patient to observation care and discharges the same day, report same-day admission and discharge codes 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ), says Dee Mandley, RHIT, CCS, CCS-P, director of HIS and education services for CURES, a coding and compliance company in Twinsburg, Ohio. You should report 99234-99236, regardless of the length of stay, as long as documentation reflects that the otolaryngologist performed both an admission and a discharge. CPT has no rules requiring a minimum stay to charge admission and discharge codes 99234-99236. Medicare, however, requires an eight-hour stay to report these codes.

"Time only matters with Medicare," says Kathy Pride, CPC, CCS-P, coding supervisor for the Martin Memorial Medical Group, a 57-physician group practice in Stuart, Fla. Otherwise, the key is that the services occurred on the same calendar day. When charging Medicare for admission and discharge on the same calendar day and less than eight hours, report initial observation care codes 99218-99220 (Initial observation care, per day, for the evaluation and management of a patient ) only, she says. Medicare reasons that for stays of less than eight hours, the physician probably didn't provide both admission and discharge services, so it will pay for one service only the admission, not the discharge. For stays longer than eight hours, assign same-day admission and discharge codes 99234-99236. Report same-day discharge and admission only when the physician visits the patient at two separate encounters and records these as two separate services. "The doctor should record the admission and the discharge under a separate heading," Pride recommends. A separate sheet of paper is unnecessary. You should not report 99234-99236 if the doctor visits the patient only once. Only one encounter occurred, so charging [...]