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Outpatient Observation 99234-99236

  1. #11
    Default
    Medical Coding Books
    In my opinion, you are right Luna. And keep in mind that the hospital admit date does NOT have to be identical to the physician admit date. Of course, observation is an outpatient service, but I think this is what the hospital is getting hung up about. Everyone here - including myself - seems in agreement that the 99234-36 codes apply. I do like cheermom's comment! Have the auditor provide the evidence that s/he's right.
    I assume you already contacted your carrier with this scenario? They might be able to provide a good resource.
    Karolina, CPC, CPMA, CEMC

  2. #12
    Location
    Milwaukee WI
    Posts
    4,466
    Default Response to COLIVER
    Yes, all the service can be performed in ONE face-to-face visit. You do not need to have two separate f-t-f visits on the same DOS to code 99234-99236.

    F Tessa Bartels, CPC, CEMC

  3. Default
    Hi Everyone!

    We are having the same issue. My scenario is the resident goes in on the 6th say 11:00 pm, the attending does not see the patient until the 7th and discharges the patient later the same day. Some say this is observation admit and discharge and other say no b/c it is different calendar dates.

    Clarification on "admit" might be helpful. Does Medicare refer to the calendar date as the actual date the patient entered the hospital or does it refer to the date the physician saw the patient. In our circumstance we allow the attending 24 hrs to utilize the residents documentation but some of the billing staff are concerned that the date of admit won't match the hospitals and that the claim will be denied. Any thoughts on the correct code? I had originally said admit and discharge same day? We are in Virginia.

    Thanks for your help!
    Mary Beth

  4. #14
    Location
    Jacksonville, FL River City Chapter
    Posts
    74
    Default
    When the admitting physician (attending, not a resident) sees the patient for the first time the morning after the patient was admitted and discharges the patient, you should NOT bill 99234-99236. It is true that the attending performed his/her initial visit on Day 2, but the 99234-99236 series is NOT an "Initial Visit and Discharge Same Day" series. It is only to be used when the patient was actually admitted and discharged the same day.

    For the situation you describe, CPT instructs (in the 6/02 CPT Assistant) that you bill a discharge only:

    "Question
    A patient is admitted for observation before midnight. The physician does not see the patient until the next day, which is also the date of discharge. The physician performs the discharge examination, discusses the patient’s stay, and gives instructions for care following discharge. Should I report codes 99234-99236 for this service?

    AMA Comment
    From a CPT coding perspective, codes 99234-99236, Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, may be reported only when the patient is actually admitted and discharged on the same date of service. The physician should not report these codes when the patient is admitted one day and discharged the next day. In this case, the patient is in the hospital for two dates of service, so the physician should report the discharge services performed on the second day of admission, which is also the date of discharge
    ."

    Realize that this CPT instruction assumes that the attending physician performed a "discharge examination" when they first saw the patient, implying that the first service by the attending occurred long after the admission and had the primary purpose of clearing the patient for discharge. In cases where this assumption is not valid--say the attending came in at 1:00 am a few hours after the patient was admitted and the attending performs a pretty comprehensive initial evaluation--then it may be more accurate (and fair from a reimbursement standpoint) to bill an Initial Hospital Care code only instead of a Discharge code only. Base your decision on the nature of the admitting's first service. But to code correctly, it has to be one of those two only, as CPT has made it clear that it is not appropriate to use the 99234-99236 series if the patient was not actually admitted and discharged the same day.

    Seth Canterbury, CPC, ACS-EM
    Education Specialist
    University of Florida Jacksonville Physicians, Inc.
    Clinical Data Quality-Education Department
    653 West Eight Street
    Tower I, Suite 606
    Jacksonville, FL 32209
    (904) 244-9643
    Last edited by SCanterbury; 09-15-2009 at 03:48 PM.

  5. Default
    Does everyone else still believe that you can bill 99234-6 for this. Since the dr's admit and d/c is on the same date, why would this not be allowed to be chosen.

    "From a CPT coding perspective, codes 99234-99236, Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, may be reported only when the patient is actually admitted and discharged on the same date of service."

    Even using this guideline, for the physician, the pt is being admitted and d/c'd the same date.

  6. Default
    please help. Now I am confused.......

  7. #17
    Location
    Jacksonville, FL River City Chapter
    Posts
    74
    Default
    No, even for the physician the patient is not being admitted and discharged the same date. The physician may not see them until the next morning but that still doesn't change the fact that they were admitted the night before.

    What is happening is that the physician is performing his initial evaluation on the same date as he will be discharging them, but the CPT Assistant is clear in stating that 99234-99236 is NOT to be used unless the patient was actually admitted by the facility and discharged on the same date. If the facility admit and discharge occurred on different DOS, then 99234-99236 is not an option, even if the physician performed his initial visit on the same date as discharging the patient.

    Could we make an argument for why CPT should allow us to use 99234-99236? Sure. But our opinions don't trump CPT's official instruction.

  8. Default What was the final conclusion?
    Read this thread and left wondering what was the final conclusion?
    It seems there are two schools of thought:
    1. admit and discharge on same day refers to calendar day that hospital shows patient admitted and discharged

    or

    2. admit and discharge on same day refers to calendar that physician saw patient and discharged them

    Anyone have sources to support one or the other side?

    I would appreciate any input.

  9. #19
    Location
    Jacksonville, FL River City Chapter
    Posts
    74
    Default
    I posted a CPT Assistant above, written by the authors of CPT and considered authoritative, that discusses this EXACT situation.

    It clearly says that you should NOT use the admit/discharge same day codes as these codes are only to be used when the hospital admission and discharge occur on the same date.

    So when the admitting physician's initial visit occurs AFTER the actual date of admission (the next morning), and he discharges the patient, he has provided an Initial Hospital Care service + Discharge, but he has NOT provided E/M services for a patient actually admitted and discharge on the same date.

    The article is clear, direct (addressing the exact issue in question), and from an authoritative source. Not trying to sound rude, but what more is needed?

    Seth

  10. Smile Colleen Chiappone, CPC
    I would appreciate clarification on the observation codes when our DR is NOT the admitting dr. All documentation I have from Medicare MedLearn indicates "If another physician's evaluation is necessary, that physician (consultant) bills the office or other outpatient visit codes".

    Some of our physicians have been told that ALL Drs following the patient can bill the observation codes, not just the "Admitting" Dr.

    Thank you

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