Observation/inpatient

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5
Location
Gilbert, Arizona
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Pt. is admitted for Obs and after two days is changed to full admit. Does this stay become a full inpatient stay? There is a little confusion here as to what happens to the obs days and if we only bill for the actual day pt was admitted to discharge?
How do we handle a 23 hour observation changed to a full admit?
thanks for you help,
Ellen
 
Last edited:

maritaj

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Irvine, CA
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You can bill for the OBS days as well as the day the patient becomes a full admit. Use the OBS initial day for day 1, then the OBS subsequent day for day two if the hospital did not change to admit on day 2. But if patient was changed to admit on day 2, you bill initial visit for inpatient code. When you charge OBS, make sure your POS is outpatient hospital.

You charge for OBS if the hospital still shows the patient on that day as OBS. When hospital changes their records to admit status, you charge inpatient code.

Hope this helps. I am traveling and do not have my CPT book to provide specific CPT codes. Sorry.

Marita
 

mhstrauss

True Blue
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1,241
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Baton Rouge
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I agree with Marita. The specific codes would be:

1st day, OBS: 99218-99220
2nd day, if status changes to inpt: 99221-99223
2nd day, if patient remains OBS all day: 99224-99226
Then if patient becomes inpt 3rd day: 99221-99223

Hope this helps as well!! :)
 

tlfisher2

New
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Amitting/treating physician

I agree with above with a clarification for the observation code selection.

If your cardiologist is providing consult services and is not the admitting and attending for the observation stay you would use outpatient new visit codes 99201-99205. Only the admitting/treating physician responsible for the observation stay meets the requirement to bill the observation codes.
 
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