Wiki E/M services

[nucarolyn]

Hi Everyone....

I am needing help with how to properly code when a patient is in observation status for a day or two in the hospital and then converted to inpatient status. On the day that the status was changed to inpatient the patient was also discharged. How should the discharge be billed? 99217 or 99238/239, the patient was in inpatient status for less than 8 hours.

I say for less than 8 hours inpatient it should be 99217 however, my colleague says it must be 99238 or 99239. Any advise would be greatly appreciated...

Thank you,
Carol M, CPC

 

[mceisele]

Hi Everyone....

I am needing help with how to properly code when a patient is in observation status for a day or two in the hospital and then converted to inpatient status. On the day that the status was changed to inpatient the patient was also discharged. How should the discharge be billed? 99217 or 99238/239, the patient was in inpatient status for less than 8 hours.

I say for less than 8 hours inpatient it should be 99217 however, my colleague says it must be 99238 or 99239. Any advise would be greatly appreciated...

Thank you,
Carol M, CPC

Hi Carol,
If it was a Medicare patient, I would follow the CPM guidelines:
(IOM), Publication 100-04, Chapter 12, ?30.6.9.1

B. Policy: When a patient is admitted to inpatient hospital care for less than 8 hours on the same calendar date, the physician shall report Initial Hospital Care using a code from CPT code range 99221 ? 99223. The Hospital Discharge Day Management Service, CPT code 99238 or 99239, shall not be reported for this scenario.

Hope this helps!

Celeste