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Observation inpatient/outpatient

  1. #1
    Columbus Ohio
    Question Observation inpatient/outpatient
    Medical Coding Books
    We are having problems with billing for patients that are in observation for longer than 8 hours but not beyond 23 hours.We(the physician) are billing as outpatient and the hospital is billing as inpatient.The E/M guidelines are not really clear as to which is correct.If we bill inpatient we get denials for no precert for admit.Which is correct,inpatient or outpatient.We are billing 99235.
    Thanks in advance for any help.

  2. #2
    Milwaukee WI
    Default Check the orders
    I have had this happen ... I went to the hospital med records and pulled the order from our physician that clearly stated: "Admit for observation" and had the hospital change the patient status to OP.

    Of course, you may find that the physician's order was just "Admit" ... In that case, the hospital is correct to assign Inpatient status and you should be using 99221-99223 OR 99234-99236 if the patient was admitted and discharged on the same calendar date.

    F Tessa Bartels, CPC, CEMC

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