Wiki Denials for obs admits

[nancy.anselmo@ccrheart.com]

This has just started to happen w/a couple of insurances. Dr will do a Cath followed by a Stent or two and then he admits them to Observation overnight. All of a sudden they are being denied for within global of 0 days, 30days or 90 day procedure. Why are they doing this. Any answer will help us to understand. I have modifier 25 on the admit. Can't use 24 because it is for the same reason the Stent was done. Thank you Nancy

 

[CodingKing]

At the insurance company I work for we bundle the Obs into the SDS unless authorized and meets InterQual criteria.

 

[nancy.anselmo@ccrheart.com]

Ok, so are you saying that the modifier 25 is not going to separate the Hospital visit from the Cath and Stents. I send in all notes when I bill. They are also talking about global

 

[linz1works4doc@hotmail.com]

admission to obs

Admission to Observation is still outpatient. Stenting, is typically considered an outpatient procedure and observation of the patient post-operatively is considered a normal part of the operative package. If the patient has complications or other co-morbidities that require an admission, then you would code it accordingly. The words "admit to observation" most times is confused as "admit to inpatient stay". A facility reimbursement method changes when a patient goes inpatient and the diagnosis becomes the factor in determining the length of stay so be sure you understand the intention before assigning POS.