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Same day admit/discharge codes

  1. Default Same day admit/discharge codes
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    If a patient gets placed in obs. or admitted and discharged in the same day, the CPT 2010 says to use codes 99234-99236. I was told in the past that if the total stay time was less than 8 hours, I had to use simply the admit (99221-99223) or Obs. (99218-99220) codes. I don't see that listed. Is it (was is ever) still true? Thanks.

  2. #2
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    Greeley, Colorado
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    It is not stated in CPT (unfortunately) but per CMS and many other insurance policies, the stay must be greater than 8 hours. If the patient is in outpatient obs for less than 8 hours we use 99213-99215 based on documentation. I have never had an inpatient obs less than 8 hours...pretty sure the hospitals UR committee would want the inpatient status on that changed to outpatient.
    Lisa Bledsoe, CPC, CPMA

  3. #3
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    Quote Originally Posted by Lisa Curtis View Post
    It is not stated in CPT (unfortunately) but per CMS and many other insurance policies, the stay must be greater than 8 hours. If the patient is in outpatient obs for less than 8 hours we use 99213-99215 based on documentation. I have never had an inpatient obs less than 8 hours...pretty sure the hospitals UR committee would want the inpatient status on that changed to outpatient.
    Observation vs inpatient is based on a physician order. The facility will only get reimbursed for observation up to 23 hours but the physician must be the one to write the order for the type of stay. The facility can request that the physician amend his order if the stay is less than 23 hours and meets the criteria for observation. So to determine which code to use look at the physician order.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Sioux Falls South Dakota
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    Do any of you have a problem getting reimbursed by Medicare for 99234-99236 with location inpatient? The codes do say observation or IP, admit and discharge the same day. We have two patients admitted to our Behavioral Health Hospital, then discharged later the same day. Their status is still IP, the psychiatrist did not change to OBS. We filed the claims with location 51, and Medicare is denying saying we have the wrong TOB (which translates to location/POS for professional claims).

    What I find on CMS' website keeps referring to these as observation care/services, but the description does say both. Any suggestions?

    Thanks,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  5. #5
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    Quote Originally Posted by mitchellde View Post
    Observation vs inpatient is based on a physician order. The facility will only get reimbursed for observation up to 23 hours but the physician must be the one to write the order for the type of stay. The facility can request that the physician amend his order if the stay is less than 23 hours and meets the criteria for observation. So to determine which code to use look at the physician order.
    True Debra - the UR committee must request it of the physician.
    Lisa Bledsoe, CPC, CPMA

  6. Default
    Thank you everyone for your responses. For the record, at my institution, I am usually coerced into changing Adm. to obs. and vise versa by UR.

    Mark

  7. #7
    Location
    Columbia, MO
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    Without the physician order??? If so that is not good practice. You should talk to the UR supervisor.

    Debra A. Mitchell, MSPH, CPC-H

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