Wiki Please help!! Outpatient Observation status

[CynthiaT]

I am not that familiar with observation codes so, I could really use some help! I am trying to select the appropriate CPT for a patient who was 'admitted to outpatient observation' on 7/2/09 and then, seen by my doctor on 7/3/09 before she was discharged home. My doctor is not the admitting or attending physician; he is a physician who had been consulted on 7/2/09 and now came back on 7/3/09 for a follow-up exam. So, which CPTs should I choose from? 99218-99220??; 99217??; or something else entirely?? My doctor had written down 99231.....but, this code is for inpatients.....

Please help me so that I can try & explain it to my physician.

Thank you!

 

[Lisa Bledsoe]

If he was following up to his consult on 7/2, the code for 7/3 would be 99212-99215; unless he actually did the discharge, which would then be 99217.

 

[CynthiaT]

I don't see anywhere in the description of the E/M codes 99212-99215 that these can be used for outpatient observation services. Can you please help me find this because my physician requires something in writing when I bring a correction to him.

Thanks so much!!

 

[aarnold13]

on page 9 in the CPT book, there is a blurp in the first paragraph after "Office or other outpatient services" - A patient is considered an outpatient until inpatient admission to a health care facility occurs." The main codes for observation are the initial observation care codes, the admit/discharge same day codes, and the discharge codes. Everything in between is a regular E/M. Under Hospital Inpatient services(pg 12) The first paragraph states "the following codes are used to report E/M servcices provided to hospital inpatients." I don't know if that helps any as to what to put in writing for the dr though.

 

[Lisa Bledsoe]

As above, CPT is a great resource. I have learned this coding over the years in workshops, can't say I remember where else I've seen it "in writing".

 

[RebeccaWoodward*]

In the rare circumstance when a patient is held in observation status for more than 2 calendar dates, the physician shall bill a visit furnished before the discharge date using the outpatient/office visit codes. The physician may not use the subsequent hospital care codes since the patient is not an inpatient of the hospital.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

30.6.8