Wiki Mult days in OBS

[dmccullers]

If we have a pt in the hosp for OBS for mult days, how would that be billed exactly? Pt admitted to OBS on 01/12 did a consult, 01/13 fu visit, and procedure and discharge on 01/14. Or vice versa, pt has procedure on 01/12, fu 01/13, discharge on 01/14. These always confuse me.

 

[jdibble]

If we have a pt in the hosp for OBS for mult days, how would that be billed exactly? Pt admitted to OBS on 01/12 did a consult, 01/13 fu visit, and procedure and discharge on 01/14. Or vice versa, pt has procedure on 01/12, fu 01/13, discharge on 01/14. These always confuse me.

I think a little more information to answer this is needed - such as did your physician admit the patient or was just the consulting doctor? What procedure was performed and are there global days attached?

If your doctor is the consulting doctor and not the admitting doctor, you would use the appropriate out-patient E/M code (new or established if your physician has seen this patient previously) based on the documentation for the consult (or an outpatient consult code if the insurance still accepts consult codes.) On day 2 you would use an established out-patient E/M code and if the decision to perform a major procedure is made, attach modifier 57 (minor procedure on same day - 25). On day three if a major procedure is done, you would bill only the procedure - no E/M and no discharge as any E/M that day would be part of the global package.

If the patient has the procedure on the first day - you can bill the consult (outpatient E/M or consult code) with a 57 modifier and the procedure. Days 2 and 3 are inclusive unless there are 0 global days - then bill the appropriate out-patient E/M for both days. You would not bill a discharge since they are not the admitting doctor.

Finally, if you are the admitting doctor, then you would use the OBS codes 99218-99220, 99224-99226, 99217 for the days that are not part of any global package. Again, if you do any procedure with more than 0 global days, any E/M after that is included in the procedure.

Hopefully this helps!