Part B Insider (Multispecialty) Coding Alert

Published on Tue Jul 25, 2006 PDF

Learn when 99234-99236 is appropriate--and when it's not

The timeframe in which a patient receives care can make major imprints on your reimbursement.
 
Medicare's eight-hour rule outlines what codes you should report based on whether the patient's stay lasts more than eight hours.

Code it this way: "If a cardiologist admits a patient, discharges her from observation on the same day, and she was there for more than eight hours, I always report 99234-99236 (Observation or inpatient hospital care [including admission and discharge])," says Jessica Carriveau, a coding specialist at Cardiology Associates of Green Bay Ltd. in Green Bay, WI. "If a patient was at the hospital for less than eight hours, I just bill the initial observation codes (99218-99220)."

You can apply the eight-hour rule to the following example:

A patient presents to the ED suffering from claudication (440.21, Atherosclerosis of native arteries of extremities with intermittent claudication). A cardiologist admits her to observation in the morning and discharges her late that night (during the same calendar day). In this scenario, you should use one of the 99234-99236 codes, depending on the level of service provided that the medical documentation supports.

Financially, Medicare's coding rule for short observation stay   may make sense. Medicare "views a same-day observation discharge more than eight hours after the admission as equivalent in work"  to an admission and discharge on different dates, says Brett Baker,  a third-year payment specialist  with the American College of Physicians.

Reimbursement: You'll recollect approximately the same Medicare reimbursement for an extended same-day observation admission and discharge as one that occurs on subsequent days. And you should challenge any insurer that adopts Medicare's observation care coding guidelines, but doesn't reimburse 99234-99236 about the same as 99218-99220 and 99217.