Question Observation Discharge Day After Elective (Pre-Scheduled) Outpatient Procedure/Surgery

mcauffman86

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I work for a Cardiology practice and our providers will order observation services for a patient after an elective (pre-scheduled) outpatient procedure is performed such as a heart cath (no global period) and keep the patient overnight for monitoring and then will discharge them the next day.

We usually will bill an observation discharge day (99217) for the day after when they are discharged. However we have a couple of payers that deny the discharge code stating that an observation discharge cannot be billed without an initial observation care code (99218-99220). We do not usually bill for the initial observation care day since it was a pre-scheduled and elective procedure and our providers usually see the patient in the office a few days before and that is when the decision is made to the schedule the procedure.

I cannot seem to find any documentation stating that an observation discharge day cannot be billed without an initial observation care code. Traditional Medicare pays the discharge code without an initial observation day just fine, so I am not sure if this is just a payer issue or if we truly should not be billing for the discharge and it is included in the payment for the procedure even though these procedures do not have a global period.

Is anyone else having this same issue or can direct me on where to find clarification on proper billing of observation discharge after elective outpatient procedures?
 

mcauffman86

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Saint Joseph, MI
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Thank you so much for this article. It really clarifies when observation services are appropriate and clearly as you said, unless a complication or another issue arises, observation is not really appropriate for just routine postoperative recovery/monitoring.
 
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