Pediatric Coding Alert

When selecting codes for short-stay hospital patients, pediatric coders should consider the site of service as well as the time spent by that patient in that site. These codes include same-day hospital admission and discharge (99234-99236, Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ), hospital admission (99221-99223, Initial hospital care, per day ), hospital discharge (99238-99239, Hospital discharge day management), initial observation (99218-99220, Initial observation care, per day ), observation discharge (for second day) (CPT 99217 , Observation care discharge day management ), hospital observation status after 24 hours (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ) and emergency department (99281-99285, Emergency department visit ). Same-Day Observation and Discharge Some service scenarios require same-day observation care codes 99234-99236. The place of service may vary, including the observation unit, emergency department or inpatient unit. The patient need not be in an observation area designated as such by the hospital to report these codes, says Richard H. Tuck, MD, FAAP, founding chair of the American Academy of Pediatrics (AAP) coding and reimbursement committee and a practicing pediatrician with PrimeCare Pediatrics in Zanesville, Ohio.

Hospital unit: For example, a parent brings a child with wheezing to the emergency room at 5:30 a.m. The pediatrician, while doing morning rounds, examines the child and admits him at 7:00 a.m. for bronchiolitis (466.19, Acute bronchiolitis due to other infectious organisms). The patient's oxygen saturations improve and wheezing resolves during the day, and the pediatrician discharges the patient at 6:00 p.m. with a nebulizer. In this case, you should use a same-day observation or inpatient admission and discharge code (99234-99236).

Observation unit: In another example, a pediatrician sees a dehydrated child in the office at 1:30 p.m. The child had presumed infectious gastroenteritis (009.1, Ill-defined intestinal infections; colitis, enteritis, and gastroenteritis of presumed infectious origin), and although vomiting and diarrhea have abated, the child still cannot tolerate oral fluids. The pediatrician sends the child to the observation unit in the hospital for intravenous rehydration. After six hours, the child is stabilized and discharged. You should use a same-day hospital admission/observation and discharge code (99234-99236) for the office visit and the observation admission and discharge combined. The code probably will be a higher-level code at least 99235 because it will incorporate the work of the office visit. Link 99234-99236 to diagnosis codes 276.5 (Disorders of fluid, electrolyte, and acid-base balance; volume depletion) and 009.1.

Note to Medicare coders: Medicare requires observation stays of less than eight hours to be billed with office visit or consultation codes, says Tom Kent, CPC, CMM, president of Kent Medical Management [...]