ED turns into Observation

VRcoder29

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I am new at ED coding. I used to do physician practice coding. BUT is it possible for a patient to be in the ED and turn into Observation care so that my ED drs can bill observation ( 99218,99219,99220,99217 ) and what has to happen in order for this to be billed?
I had an alcoholic that came in on 4/12 - she was so drunk she had to be monitored and kept until after 4-13 . Some of the ladies in the office thought maybe we could bill outpatient obs. However, I only have billed from the provider side of non emergency and I know the hospital ( I think ) has to order it to be observation and not ER .. ( I might be wrong here so please let me know nicely if I am )
So all in all let me know if it is billable for Ed physicians ? and if so how do we determine it is billable?

Thank you
 

roxbejinariu

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The physician must admit the patient to "observation" status. And only the admitting/supervising physician can bill obeservation care codes. Any other consulting physician has to bill regular EM consult/or 99203...etc if the patient is Medicare.
 

VRcoder29

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Forgive me ( because like I said I have only done ED for about a month) When I done family practice , the order usually came from my family practitioner but only once the hospital had notified them , therefore that meant that my FP was the only one who could bill for the observation ... is that correct ?
In this case right here , the ED physician can't make the decision himself just to put in observation without the facility backing that correct?

The physician must admit the patient to "observation" status. And only the admitting/supervising physician can bill obeservation care codes. Any other consulting physician has to bill regular EM consult/or 99203...etc if the patient is Medicare.
 

jljdmjkmj

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hello,

in my understanding the physician who admits the patient into the observation status is the one needing to observe the patient in order to determine if pt can be discharged or needs to be admitted to the hospital. This provider is following the care during this time.

There are strict guidelines for the admitting physician as far a documentation on the encounter and it typically is for 24-48 hrs. it can be longer but, average is 24-48.

please let me know if my understanding is not correct. I'm still brushing up my skills in this area too. :)

Thank you
 

kak6

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Oh my this is a bigger subject than can be covered here w/a simple answer. first of all there has to be medical necessity for observation status (sleeping off a drunk does not qualify). You can easily go to CMS web site and search for observation services, I think that would be best for you to read and study yourself you will learn more than you barged for.
 
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