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Observation IP or OP

  1. #1
    Question Observation IP or OP
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    I need some insight on how to bill observation codes. My first instinct would to bill as an outpatient since technically the patient was not yet admitted to the hospital. However, in the terminology of the CPT description it states "Oservation/Inpt hosp care, making me question whether it should then be coded as In patient. For example, Doctor is billing 99235 admit/discharge from observation on same day, is this inpt or outpt? Thanks, I appreciate any suggestions on how to code this.

  2. #2
    Evansville Indiana
    Default observation
    Observation is billed as outpatient POS 22.

  3. #3
    Thumbs up Observation IP or OP
    Thank you very much.

  4. Default
    As a matter of fact the the observation care , before admission in a hospital. But our concern is about the initiation status-what we call as OBSERVATION STATUS. This observation status is the "initiation of status" they start with, who are to designated later to OB.Care admission.My point is where this intiation status starts is our concern now. In other words, dont we label this place as the POS .This can be as per the CPT manual, initiated in the course of an encounter in another site of service, eg, Hospital Emergency department, physicians Office, nursing facility like that.
    So dont we refer this site of encounter as the POS and if so, it can vary depending upon the place the patient's first encounter for service.
    Then how can we label/ fix the POS as 22?. Where does this ED service fall into then- 20or 21 or 22 or 23? Well, it is confusing to me!

    Yet another question is: For eg, a patient is sent from primary Physician to the ED for observation into labor; the patient is being evaluated there for initiation of Observation status; Two things can happen here ;
    1. Initiation status provided by ED physician and all ok on evaluation and could be sent back home.
    2. on Intiation observation Status and giving assessment , physician decided to send for 23 hours obs, or inpatient care services
    3. from where she could land up for delivery suite or sent home "saying not in lalor".

    Now whcih is the POS for all these services? who is the one who claims for E/M service for each one of this categories.
    By and large, will this patient be entitled for observation services and if from which stage of the scenerio?
    If she was sent home from the ED at the very initiation of observation status, say about less than an hour or two, would he/she be eligible for OBSERV Services code 99218-99220 or the physician just code for E/M from 99201-99215

    I wish some one can give me a clear picture of all these collobarative scenerio of E/M
    of defferent categories ( not the straight forward one of dealing with one POS scenerio)
    Please do not give me a site to browse with. No time please!
    Thank you in advance.

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