Primary Care Coding Alert

These 2 scenarios can help you get observation coding right each time If you-re not cued in to the finer points of observation services coding, your practice could be missing out on reimbursement you-re fully entitled to.
 
Financial impact: If coders inappropriately report a standard evaluation and management code when the FP performs an observation, the practice's bottom line will suffer. In Wisconsin, for example, Medicare pays $60.34 for level-one observation code 99218, while it pays $34.87 for level-two E/M code 99212, says Quinten Buechner, ACS-FP/GI/PEDS, CPC, CCP, CMSCS, president of ProActive Consultants in Cumberland, Wisc. Code First Day of Stay With 99218-99220 Use observation code set 99218-99220 for the first day of observations that span more than one calendar date, says Caral Edelberg CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth in Jacksonville, Fla.
 
-These initial observation care codes are reported only by the supervising or attending physician when the patient is admitted to observation. These codes include initiation of observation status, supervision of the care plan for observation and performance of periodic reassessments,- she says.
 
Example: Consider this low-level observation encounter, courtesy of Buechner: A diabetic patient complains of increased nausea and vomiting, which doesn't appear to be related to his diabetic condition. The FP examines the patient in the hospital emergency department (ED), performs and dictates a detailed history and exam, records medical decision-making (MDM) of low complexity and admits the patient to observation status. During the observation period, the FP gives the patient IV fluids with electrolytes, insulin and antiemetics to treat his symptoms.
 
On the claim, Buechner says that you would:

 - report 99218 (Initial observation care, per day, for the evaluation and management of a patient which requires these three 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 observation service.

 - attach 250.02 (Diabetes mellitus without mention of complication; type II or unspecified type, uncontrolled) to 99218 to represent the patient's diabetes.

 - attach 787.01 (Nausea with vomiting) to 99218 to represent the patient's nausea and vomiting. Explanation: Even though the FP provided services at two separate sites (ED, observation), -all of the services are reported with one code (99218), since the care provided in both sites is related to the same condition/ problem,- Buechner says. 
 
Authority: This is consistent with CPT guidelines, which state, -When -observation status- is initiated in the course of an encounter in another site of service (e.g., hospital emergency department, physician's office, nursing facility) all evaluation and management services provided by the supervising physician in conjunction with initiating -observation status- are considered part of the initial observation care when performed on the same date.-  
 
If a patient is in [...]