Detailed HX so cannot bill OBS?

kemasters

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Is it common practice to revert back to an ER code (99284-99285) when there is not a comprehensive hx because the 99284-99285 is more $$ than a 99218 (initial OBS with a detailed hx)??
 

jimbo1231

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Obs vs ER

Coding based on which service pays more as an overriding basis for the code could be viewed as abusive or fraudulent. If the coder has no choice but to down code what clinically obviously looks like a higher Level based on lack of documentation, that is acceptable. But if admission to Observation is documented and ED is purposely coded for more reimbursement, not a good practice. Also with Observation the opportunity is there for a discharge code if the patient is kept overnight. Also the right codes for same day discharge from Obs are 99234-6 if documentation and hours in Obs requirements are met. They pay pretty well.

Jim
 

nomerz

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Is it common practice to revert back to an ER code (99284-99285) when there is not a comprehensive hx because the 99284-99285 is more $$ than a 99218 (initial OBS with a detailed hx)??

99218 states detailed OR comprehensive history/exam so you should still be billing obs if your documentation adequately supports the code...
 
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