snwhite0730
Contributor
I have documentation where a patient was seen twice on the same day in the ER and admitted for observation on both visits. Same code 99284 reported twice on the same date of service for the same patient.
He was admitted from the ER by Dr. L for OBS. Dr. L completed the ED and OBS care and discharged the patient and reported 99284. (I say this was also reported wrong but my audit is for Dr. D and not Dr. L).
The same patient was brought back to the ER and admitted for observation by Dr. R. (no codes reported for Dr. R).
Once he is in OBS, the patient is seen by Dr. D.
Dr. D does the observation care and discharges the patient.
Dr. D also reports ER code 99284.
I say Dr. D reported the wrong code since the patient was already in OBS when he rendered care and he should therefore report OBS codes 9922x and also that because this is the same date of service and same facility a subsequent care code should have been used for the re-admit for the same diagnosis and date of service. My manager is saying that more than one ED code can be reported on the same date of service as long as the documentation supports it. I disagree since all three notes clearly state the patient was admitted for observation.
I am confused as to what is reported when they are seen in the ED and then admitted for observation, would you report the ED or OBS?
I have read the guidelines, and it seems clear to me that once they are admitted to observation, all care, including the ED visit is 'bundled' into the OBS codes and that is what is reported.
Any help or clarification would be greatly appreciated.
He was admitted from the ER by Dr. L for OBS. Dr. L completed the ED and OBS care and discharged the patient and reported 99284. (I say this was also reported wrong but my audit is for Dr. D and not Dr. L).
The same patient was brought back to the ER and admitted for observation by Dr. R. (no codes reported for Dr. R).
Once he is in OBS, the patient is seen by Dr. D.
Dr. D does the observation care and discharges the patient.
Dr. D also reports ER code 99284.
I say Dr. D reported the wrong code since the patient was already in OBS when he rendered care and he should therefore report OBS codes 9922x and also that because this is the same date of service and same facility a subsequent care code should have been used for the re-admit for the same diagnosis and date of service. My manager is saying that more than one ED code can be reported on the same date of service as long as the documentation supports it. I disagree since all three notes clearly state the patient was admitted for observation.
I am confused as to what is reported when they are seen in the ED and then admitted for observation, would you report the ED or OBS?
I have read the guidelines, and it seems clear to me that once they are admitted to observation, all care, including the ED visit is 'bundled' into the OBS codes and that is what is reported.
Any help or clarification would be greatly appreciated.