I am preparing a summary for my physicians, who are struggling to understand how/when to use observation codes. I need some opinions, is this information correct and clear?
We have added some new codes to be used in the hospital setting. These codes are for patients who have been admitted to observation status in the hospital. When you are submitting billing for any of the observation codes you need to identify the service you are providing as follows:
The short version - an explanation of how to submit your billing
Observation admission - low, moderate or high
Observation admission and discharge - low, moderate or high
Observation follow-up, level 2 - 5
The key to billing for these services is to indicate on your billing "Observation."
The detailed version - an explanation of the codes
99218, 99219 and 99220 - Initial observation care
These codes are used on the day the patient is admitted to observation status.
99218 - detailed history, detailed examination, MDM straightforward/low complexity
99219 - comprehensive hx, comprehensive exam, MDM moderate complexity
99220 - comprehensive hx, comprehensive exam, MDM high complexity
If the patient is admitted to observation status and discharged/expired the next day you would bill 99217 for the discharge. (If the patient is discharged LESS than 8 hours after admission, you do not bill this discharge code, you would bill only the 99218 - 99220 code.)
If the patient is admitted to observation status and then discharged, or expired, on the SAME day you would bill using:
99234, 99235 and 99236 - Observation or Inpatient Care Services, including admission and discharge.
(If the patient is discharged LESS than 8 hours after admission, you do not bill this discharge code, you would instead bill ONLY the 99218-99220 code.)
99234 - detailed history, detailed examination, MDM straightforward/low complexity
99235 - comprehensive hx, comprehensive exam, MDM moderate complexity
99236 - comprehensive hx, comprehensive exam, MDM high complexity
If the patient remains in Observation status for a few days you would bill for the subsequent visits using the office/outpatient codes 99212 - 99215.
Day 1 - pt admitted to observation status, 99219
Day 2 - pt seen in follow-up/subsequent visit, 99213
Day 3 - pt is discharged home from observation, 99217
If a patient is admitted to inpatient status in the hospital on the same day as the Observation admission you do NOT bill for the observation code. You would only bill for the hospital inpatient admission, 99221 - 99223.
If you are billing for any of the observation codes the place of service will be 2, for outpatient.
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