Wiki Observation versus ER vist and in or outpatient E/M

Create Wiki
M

MARY K

Networker
Messages
82
Location
Susquehanna, PA
Best answers
0
We are a private practice specializing in Orthopedic Surgery, with on call duties at the local hospitals. Recently we hired a new coder, who believes our physicians should be using the observation codes when called into ER or when the patient has been admitted by Hospital Medical Services. We have always used the ER, in or outpatient E/M codes. Any opinions or reference links would be appreciated
 
Obs codes would only be used if the patient was in observation status. Inpatient codes would be used if the patient is inpatient status. It doesn't matter where the patient is in the hospital. For instance a patient can still be in the ER but on observation or inpatient status. Bed availability in the specific area in the hospital doesn't dictate the patients status.
 
You are correct, if the hospital medical services had admitted the patient to observation status, those physicians will bill the observation codes, and your physicians would bill the ER or Outpatient E/M codes, depending on if they saw the patient before of after the admission to observation status. This is detailed really well in the MLN Matters publication # 6740, link here:

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/MM6740.pdf

"For patients receiving hospital outpatient observation services who are not subsequently admitted to the hospital as inpatients, physicians should report CPT codes 99217-99220. In the event another physician evaluation is necessary, the physician who provides the additional evaluation bills the office or other outpatient visit codes when they provide services to the patient."
 
If your physician sees the patient in the ER and the patient is not admitted to another area of the same facility by any provider (Observation or IP) and goes home from the ER, your physician will bill the appropriate ER code.
If the patient is admitted, then your physician's consult will be either an IP or OP consult, (or the appropriate new patient or established patient code if a consult code is not accepted).
It should be possible to know whether the patient has gone home from the ER or been admitted.
I audit a lot of E&M and many coders struggle with theses scenarios. So, patient seen in ER and goes home, ER code, otherwise other appropriate E&M as above.
Hope this clarifies what can be a confusing concept but is basically straightforward.
 
You must log in or register to reply here.
Top