Pulmonology Coding Alert

8-hour mark crucial for Medicare patientsWhen your pulmonologist performs observation services, pay attention to the number of days (or hours) the patient remains in observation. And once you arrive at the proper code, be sure you've got all the supporting documentation in order before sending the claim off.Check out this primer on coding the different types of observation services.Use 99218-99220 for First DayReport codes 99218-99220 for the first day of observations that last multiple days, says Gerry Salwek, RHIT, CPC, coding manager at Caledonia Financial Services in Plantation, Fla.The admitting physician uses 99218-99220 for the patient's initial day of observation, unless the patient happens to be subsequently discharged to home or admitted to inpatient status on the same calendar day.The initial observation care codes include all of the E/M services the admitting physician (or another physician of the same specialty in the same group) provides the patient for that entire day, including office, ED, or other visits leading up to the admission to observation (regardless of location).Warning: Be on the lookout for services that might appear to be observations but really aren't, says Joan Gilhooly, CPC, CHCC, president of Medical Business Resources LLC, in Deer Park, Ill. Attempting to categorize everyone who requires lengthy treatment in the hospital as an observation patient is not good practice.Example 1: A 65-year-old patient with moderate airflow limitation due to chronic bronchitis and emphysema is admitted to observation for acute bronchitis. The pulmonologist performs a comprehensive history and a comprehensive examination along with medical decision-making of high complexity. Initially, the saturation is satisfactory and the provider starts the patient on antibiotics and bronchodilators by inhalation. Within two hours, the patient's condition begins to deteriorate, the saturation falls and the pulmonologist decides to admit the patient to the hospital.This is a hospital care service, not an observation. On the claim, report 99223 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a detailed interval history; a detailed examination; medical decision-making of high complexity) for the initial evaluation with 491.22 (Obstructive chronic bronchitis; with acute bronchitis) to describe the acute bronchitis."By definition, someone is admitted to observation because you're still trying to figure out whether his condition requires extended treatment in an inpatient setting," Gilhooly says. Keep this in mind when trying to decide if an observation code is the most appropriate code to report.Example 2: A 68-year-old patient with bronchiectasis and a pleural effusion undergoes thoracentesis at the hospital. A few hours later, the patient is admitted to observation because a post-thoracentesis chest x-ray demonstrates a mild- to moderate-size pneumothorax. The pulmonologist performs a detailed history and a detailed examination along [...]