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Observation to Inpatient

  1. #1
    Seacoast- Dover New Hampshire
    Default Observation to Inpatient
    Medical Coding Books
    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.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
    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

  3. #3
    Default 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.

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