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Thread: 16 days of observation status (medicare)

  1. #1
    Join Date
    Apr 2007

    Question 16 days of observation status (medicare)

    AAPC: Back to School
    okay folks I need your help....
    pt was admitted to OBS from ER due to fam not picking pt up...I am expected to code the entire 16 day observation stay for the professional side...pls help?
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Wow - I'm speechless

    16 days in observation?!

    Initial observation for the first day.

    Established patient "office" visit for each of days 2-15.

    Discharge from observation for day 16.

    Good luck!

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Swainsboro/Statesboro, GA

    Default Physician's order and medical necessity

    I recommend that you review the patient's medical record at the facility. Admission to observation (for Medicare) has strict guidelines. There has to be a physician's order and there has to be medical necessity for the admission. If neither exists, the facility cannot bill this to Medicare.

    Another thing to keep in mind is that an admission to the facility as an inpatient also must meet criteria. The length of time a patient is at the facility is NOT a reason to support an admission (of any type). Medicare is very specific in stating that an admission is not covered if it is provided for the convenience of the patient or family.

    Again, I recommend that you review the medical record for medical necessity before any billing is done. If there is documentation to support the medical necessity of the stay, and the physician wrote an order to admit to Observation status, I agree with the coding Tessa provided.

    Good luck!!!
    Freda Brinson, CPC, CPC-H, CEMC
    2014 President AAPC Swainsboro, GA Chapter
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)

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