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Observation codes-coding hospital charges

  1. Default Observation codes-coding hospital charges
    Exam Training Packages
    I am coding hospital charges for a family doctor who sees both IP and OBS patients.

    My question is this: Per the facility records, the patient is placed in obs by ER physician on 03/15 and DC date is 03/16. The family doctor sees the patient in OBS only on 03/16 and DCs the patient to home.

    In this scenario, is it appropriate to sue the codes 99234-99236 for the family doctor's sevices, even if the facility records state the patient was in OBS on 2 consecutive days?

  2. #2
    Loma Linda
    Was he asked to come in for consult??? If he was it would be billed as outpatient consult 99241-99245. The OBS codes can only be used by the one that put them there. Everyone else uses outpatient codes... and if the pt stays additional days on obs the MD that put them there can bill subsequent outpt codes as well. We just went through all this in our office.
    Last edited by amsmith; 04-01-2010 at 04:50 PM. Reason: additional info

  3. #3
    Milwaukee WI
    Default Transferred care?
    So, Day 1 the ED physician admitted the patient to observation status ... ED physician uses the 99234 code. At least at OUR hospital, an ED physician is NOT going to keep following the patient. (For that matter, at our hospital the ED physician would NEVER be the admitting physician.)

    There should be some record of a transfer of care or a change in attending physician to the family doctor.

    The family doctor would then use the the observation discharge code for day 2.

    If care was NOT transferred, I believe you can only code the established outpatient visit.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. Default
    Why would the ER physician use the 99234 code? It seems to me like the ER provider would use the codes for ED visits, the 99281-99284 codes?
    The ER physician is transferring care, he would not follow this patient under any circumstances. As soon as the patient goes to Obs, they are under the care of the PCP.

    And he was not asked to come in for a consult, he came in because it is his patient, he is the PCP. It would not be appropriate to bill the consult codes.

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