Bernadette10
Guru
A patient was admitted to observation in the evening of Jan 10 by a resident and was not seen by the attending physician until late morning on Jan 11 and was discharged on 1/11. There is one note for Jan 10 signed by the resident only, and there is one note signed by both the resident and attending on 1/11 for the observation discharge. What is billed? Initial obs 99218-99220? I think it would be 99234-99236 if there were 2 notes on Jan 11 showing the patient was there for at least 8 hours, but that's not the case here. Is my thinking correct? I think the sentence I highlighted below says this, but I'm doubting myself. Thanks for any reassurance!
The ins and outs of billing observation - Today's Hospitalist (todayshospitalist.com)
Then there’s this academic scenario: how to bill for an observation patient first seen by a resident on day 1 at 10 p.m., but not by an attending until day 2 at 8 a.m.
If the patient is ready for discharge on day 2 as well, should the attending bill the second day as a same-day admit and discharge (99234-99236)?
The answer is yes: You must base your claim on the supervising physician’s date of service, so you can’t bill for the first day when only the resident saw the patient. In this case, day 2 would be considered the only date of service.
Another wrinkle: Medicare has an eight-hour minimum for physicians reporting observation same-day-discharge codes (99234-99236). If a patient is in observation for less than eight hours on one calendar day, you would bill initial observation care codes (99218–99220). But you can’t bill a discharge for that patient.
If, however, an observation stay is less than eight hours but spans two calendar days, physicians should bill initial observation care (99218-99220) on day 1, then the discharge code (99217) on day 2.
The ins and outs of billing observation - Today's Hospitalist (todayshospitalist.com)
Then there’s this academic scenario: how to bill for an observation patient first seen by a resident on day 1 at 10 p.m., but not by an attending until day 2 at 8 a.m.
If the patient is ready for discharge on day 2 as well, should the attending bill the second day as a same-day admit and discharge (99234-99236)?
The answer is yes: You must base your claim on the supervising physician’s date of service, so you can’t bill for the first day when only the resident saw the patient. In this case, day 2 would be considered the only date of service.
Another wrinkle: Medicare has an eight-hour minimum for physicians reporting observation same-day-discharge codes (99234-99236). If a patient is in observation for less than eight hours on one calendar day, you would bill initial observation care codes (99218–99220). But you can’t bill a discharge for that patient.
If, however, an observation stay is less than eight hours but spans two calendar days, physicians should bill initial observation care (99218-99220) on day 1, then the discharge code (99217) on day 2.