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Patient in observation for 2 days then admitted to inpatient.

  1. #1
    Question Patient in observation for 2 days then admitted to inpatient.
    Medical Coding Books

    I am an inpatient physician coder. I code for a number of hospitalist and am seeing this scenario more and more. The patient is initially seen by the hospitalist on 7/3/11 in observation. The hospitalist dictates his/her H&P. The next day the hospitalist rounds and the patient is still in observation. The next day the hospitalist writes the order to have the patient admitted to inpatient status. The hospitalist then rounds the next 2 days and finally discharges the patient on the 3rd day of inpatient status. So here it is:

    7/3/11 Observation initial visit and H&P
    7/4/11 still in observation
    7/5/11 orders written to inpatient status (hospitalist dictates a subsequent visit progress note.)
    7/6/11 inpatient
    7/7/11 inpatient
    7/8/11 face to face and discharge dictated

    How should this be coded? Any help and direction is appreciated.

  2. #2
    7/3 = 99218-99220 depending on documentation, plus total observation hours.
    7/4 = 99224-99226 depending on documentation
    7/5 = 99221-99223 depending on documentation
    7/6 = 99231-99233 depending on documentation
    7/7 = 99231-99233 depending on documentation
    7/8 - 99238-99239 depending on documentation

    per coding clinic, if a patient is admitted to inpatient status from observation, only the inpatient e/m is used, unless the patient goes to a long term care facility. also, the physician has to complete a new H&P for the inpatient stay because observation is an outpatient service. at least that is what I have been told, and this is what our facility practices. not sure what other facilities do on the H&P part of it though....

  3. #3
    Kansas City, MO
    I've heard from our nurses that when they call to notify of a change from obs to inpatient status, that some insurance companies are telling them they must bill the entire stay as inpatient, and that they (the ins co) are retroing the date. If we try and bill part obs, and part in-pt they will deny it.

    Anyone else experiencing this?
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC, AAPC Fellow
    PMCC Licensed Instructor
    2018 Chapter President, Kansas City, MO

  4. #4
    Thank you Maudys and Linda,

    I have been coding it like Maudys stated, but now I have been told by others that it should be coded the way the nurses are telling Linda. It's a bit frustrating

    Brendan, CPC

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