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E/M Coding During Observation Days

  1. #1
    Talking E/M Coding During Observation Days
    Medical Coding Books
    Hi there--

    I was wondering if anyone has run into this conundrum--

    A fellow coder is struggling with what to do when an E/M code is assigned for a doctor visit while the patient is in oberservation status. The problem that is arising is that some of these patients change over to inpatient on their second or third day after the doctor visit. So the quandry is:

    Patient comes to hosptial, and is oberservation from 5/9 to 5/11
    Patient admitted as inpatient to hosptial on 5/11, discharged on 5/13.

    When the coder tries to code the account, she is running into the problem that she cannot bill for her E/M services because they fall outside the inpatient admission. Has anyone dealt with this problem? Perhaps this is all just due to a flaw in our workflow/processes, but I wondered how others may have dealt with this. Please help!

  2. #2
    When the patient is in observation status, use the observation codes (5/9+10). When the patient transfers to inpatient admission, use initial admission code (5/11) and subsequent care codes (5/12), finally the discharge code (5/13) as appropriate. See page 11 of CPT 2009 for clarification.
    This is how I would code the situation, hope it is useful.

  3. #3
    Sorry, I meant to put the codes in the comment as well:
    Observation: 99218, 99219
    Initial Admission: 99221 - 99223
    Subsequent Care: 99231 - 99233
    Discharge: 99238 or 99239

  4. #4
    Milwaukee WI
    Default Day 2 in observation
    You would use established outpatient visit for day 2 in observation.

    5/9/09 - 99218-99220 Initial Observation Care
    5/10/09 - 99211-99215 Established patient visit
    5/11/09 - 99221-99223 Initial Hospital visit
    5/12/09 - 99231-99233 Subsequent hospital visit
    5/13/09 - 99238-99239 Hospital discharge

    F Tessa Bartels, CPC, CEMC

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