Observation codes

Beany011178

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Can someone explain to me the 8 hour rule for Observation status? I have a pt that was in the hospital for observation status on one day and then went home the next day. She was there for more than 8 hours so that rules out 99218-99220 and she was admitted and discharged on different dates so that rules out 99234-99236.

Please help me!!!!!
 

Herbie Lorona

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I have never heard of the 8 hour rule for observation status. If the patient was observation one day and discharged the next i would use 99218-99220 for the first day and 99217 for the discharge. Where did you get this 8 hour rule from?
 

valariej

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CMS rule states:

Pt must be in OBSV for a minimum of 8 hours on the same calendar date to bill for 99234-99236. If the pt is admitted for less than 9 hours use the 99218-99220 codes. NO discharge is billed in this case.
 

Herbie Lorona

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Ok that makes sense. I wasn't thinking about on the same calendar date because the question was about 2 different days. So either way in this case you would bill 99218-99220 for the first day and 99217 for the second day.
 
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