Wiki Observation

[GDURHAM]

A patient is admitted to observation and then changed to in patient on day three. Can I bill for the obs admission and one subsequent day and then the admission to inpatient or do I have to forget about the obs days and only charge in patient days?

 

[LindaEV]

Here is what Medicare says:

Question 4: Please help me to better understand outpatient observation to acute inpatient. If the patient is admitted to observation status on Monday, admitted to an inpatient history on Tuesday, and then discharged from inpatient status on Wednesday. How would we bill these services?
Answer: The admission of a patient in observation status is procedure codes 99218 - 99220. The admission of the patient to inpatient status on Tuesday is procedure codes 99221 - 99223. The discharge on Wednesday is procedure codes 99238 - 99239. The code chosen is based on where the service is provided and the level of care provided. You can find more information on observation services in the CMS IOM Publication 100-04, Chapter 12, Section 30.6.8.D.

 

[nkknav4]

Pls help with coding observation for a pt who has Medicare. Pt was OBS and seen by the Hospitalist (different provider) then referred to our provider for a consult for Gastro. How do I code our visit? Some Coders are stating use E/M codes?

 

[Tonyj]

Pls help with coding observation for a pt who has Medicare. Pt was OBS and seen by the Hospitalist (different provider) then referred to our provider for a consult for Gastro. How do I code our visit? Some Coders are stating use E/M codes?

Being that the patient is in observation and your GI was called in to consult you would follow E&M outpatient codes with POS 22 (9920x or 9921x) or depedent upon the carrier, consult code (99241-99245)

As per CMS;
Only the practitioner who orders, and is responsible for the patient’s care while receiving observation services, can bill for observation services.
All other practitioners bill office/outpatient codes. Rules for new vs. established patients apply.