Wiki Hospital Visits

[deynaw]

Good morning,
Can someone please clarify the regulations (and if you can please provide where I can find the info in writing) on hospital emergency room and observation codes.
Does the hospital status determine the way the specialist charges (i.e: if the pt is listed in observation status then the observation codes are used/ if the pt is listed in ED status then those codes are used etc).
I was recently at a conference and one of the speakers stated that the only time that you use the obs code (specifically on medicare pts) is if your physician places the pt in observation. otherwise the outpt e/m code is used...is that true?

 

[mhstrauss]

Good morning,
Can someone please clarify the regulations (and if you can please provide where I can find the info in writing) on hospital emergency room and observation codes.
Does the hospital status determine the way the specialist charges (i.e: if the pt is listed in observation status then the observation codes are used/ if the pt is listed in ED status then those codes are used etc).
I was recently at a conference and one of the speakers stated that the only time that you use the obs code (specifically on medicare pts) is if your physician places the pt in observation. otherwise the outpt e/m code is used...is that true?

The info the speaker gave is correct; here is a link to an article from CMS:

https://www.cms.gov/MLNMattersArticles/downloads/MM6740.pdf

(The Obs & ED info is on pages 4-5)

However, private payers may have different policies; some still allow your provider to use observation codes even if he/she did not actually place the patient into observation status.

Hope this helps!!