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inpatient and observation codes

  1. Default inpatient and observation codes
    Exam Training Packages
    When billing for professional E&M services the physician submits a charge for an inpatient stay. The hospital information states the patient was in observation on the first and second day and then converts the patient to in-patient on the third day. Is it correct to keep the professional billing as in-patient for all days or does the professional and hospital billing need to match?

  2. Default
    Physician coding/billing must match the patient status reported by the hospital.

    If they have the patient as
    day 1 outpt/OBSV
    day 2 outpt/OBSV
    day 3 inpatient
    then your E&M codes must reflect these same POS.

    The reimbursement for inpatient care vs outpatient care is different for the facility and for your E&M codes. If you report differently from what the hospital has reported, your E&M services will be denied

  3. #3
    Kansas City, MO
    Remeber to only use the Obs codes if your physician was the one admitting pt to observation, otherwise use outpatient codes
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  4. Default
    Here is a paste of the guidelines for coding OBSV

    Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient's observation services began.

    All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes.

    Example: If an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial observation care code. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate.

  5. Default
    Thank you.

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