Observation coding HELP!!!

[lparrish]

Can anyone tell me the rules for Observation coding. If a patient comes in to the ER and is admited to Observation on the same day, are these considered 1 encounter or 2 encounters? (1 per department)

Need help.

 

[ajs]

Can anyone tell me the rules for Observation coding. If a patient comes in to the ER and is admited to Observation on the same day, are these considered 1 encounter or 2 encounters? (1 per department)

Need help.

CPT book guidelines page 13:
"When "observation status" is initiated in the course of an encounter in another site of service (eg, hospital emergency department, physician's office, nursing facility) all evaluation and management services provided by the supervising physician in conjunction with initiating "observation status" are considered part of the initial observation care when performed on the same date.

So if the same doctor saw them in the ER and then admitted them to observation, only one E/M code is reported for the day. If two different physicians provided the services then you can report two separate codes, 1-ER and 1-observation status.

 

[FTessaBartels]

When are Two doctors considered ONE?

Arlene is correct -- except ...

If the two different physicians who saw the patient are of the same practice AND the same specialty, they are considered ONE physician. In which case only the Initial Observation Care service can be charged, though you can use ALL the documentation to arrive at the appropriate level.

Hope that helps.

F Tessa Bartels, CPC, CEMC