• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

Observation to Inpatient

kbarron

True Blue
Messages
609
Location
Ossipee, NH
Best answers
0
We have a pt that was admitted to observation, the next day she became a full inpatient admit. I have used the 99218-99220 for day one and 9922x on the next admit day. Is there documentation guidelines for this senario? What if the oppposite happens. Pt comes in full admit and then the next day she becomes observation? Do we need documentation for the different stay types? They are 2 different places of service.
 

charlna

Networker
Local Chapter Officer
Messages
27
Best answers
0
In this senario I would have billed an observation code 99218-99220 for the first day and then when the patient was admitted on the second day I would have started billing inpatient subsequent visits 99231-99233. I have not billed an inpatient initial visit in this case, however if the physician did not write an admit note until the next day I would have billed the initial inpatient codes 99221-99223. Hope this helps. I would also like to hear others opinions on this. Thanks
 

jliving77

Networker
Messages
45
Location
Tucson, Arizona
Best answers
0
Obsv to Inpt

When the patient is in observation, once any hospitalist decides to admit the patient, the entire stay is reverted to inpatient. Patients that are already inpatients will never go to observation status.
So for your scenerio the very first day of the patients care would then be an admission 99221-99223, even if it's another doctor that decides on another day of the same stay to admit the patient, i.e; the doctor who did the admit to observation would then get to bill for admission 99221-99223; with the actual deciding doctor being the referring/admitting doctor. I don't know about you, but we have to out the admitting doctor on all of our claims. This is always different from the doctor who actually DOES the admitting.
I'm pretty sure the documentation for this starts under the heading and descriptions for Hospital Observation Services and under Hospital Inpatient Services.
Hope this helps.
jen
 
Top