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Observation codes-If we see a pt

  1. Default Observation codes-If we see a pt
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    If we see a pt in the ER and decide to do an emergent appendectomy on them can I use a 99218-99220 E/M plus bill for the procedure? or would it be considered global?

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    i should mention this all would take place in less than 24 hrs...

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    I have always used the -57 modifier in the past when I was coding for cardiothoracic. However, in my current position I was told I had to use the observation codes if the pt is not in the hospital for 24 or more hrs, which i did not think you could use the mod -57 with these codes and I was told I could not use the initial in pt codes due to the less than 24 hr deal and they are not really admitted as in pt's these procedures go to ambulatory sx... any furhter clarification would be appreciated.

  4. #4
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    Quote Originally Posted by skm510@live.com View Post
    I have always used the -57 modifier in the past when I was coding for cardiothoracic. However, in my current position I was told I had to use the observation codes if the pt is not in the hospital for 24 or more hrs, which i did not think you could use the mod -57 with these codes and I was told I could not use the initial in pt codes due to the less than 24 hr deal and they are not really admitted as in pt's these procedures go to ambulatory sx... any furhter clarification would be appreciated.
    I code for General Surgeons, Ortho and ENT and come across this situation every day. From your question it is not really clear why you would pick observation codes.

    The code you choose would depend on alot of different factors and the status of the patient - placed in Observation (OB) or admitted (IP) or just brought to surgery from the ED. The status of the patient depends on whether or not they meet the criteria for IP or OB. A patient can be IP less than 24 hours. If the patient is IP less than 24 hours on the same date, or in OB admitted and discharged on same date you would use codes 99234-99235. If they are in OB over 2 different days then you would use the codes 99218-99220. If the patient was just taken to the OR from ED and then went home afterwards as in ambulatory surgery, then you cannot use observation codes.

    Now, if your doctor is the General Surgeon and the ER doc called them in for a consult, then the initial visit would be the consult for the surgery. If the patient is non-medicare then the codes would be for an Outpatient Consult if the patient was not admitted into OB or IP by himself or another doctor. If your doctor is admitting the doctor himself into OB then you would use the OB codes appropriately based on day of admit and discharge as above or if he admits the patient IP then he would use the Initial visit codes (99221-99223). If the patient was admitted by another doctor, the code would be inpatient consult for non-medicare and initial visit for medicare. If the patient is not admitted into either OB or IP and is just seen in the ED and taken to Same Day Surgery, then the doctor would again use Outpatient Consults for non-medicare and he would use the ED codes for a Medicare consult. All of these E/M codes would require the 57 modifier to bill with the surgery.

    I hope this all makes sense!
    Last edited by jdibble; 07-14-2011 at 01:41 PM.
    Jodi Dibble, CPC

  5. #5
    Location
    Kansas City, MO
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    If your surgeon truly performed a consult and made the decision for surgery, then you would either charge a outpt consult (commercial ins) or an ED code (medicare) with a 57 modifier, and the surgery.
    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

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    Thank you for your help! Yes, I does make sense to me... and in the past I would have billed a consult code w/57 mod. However, I was told that was incorrect when I started at this office due to that fact the pt was not admitted for more than 24 hrs... I've noticed that the 99218 etc.. are not paying... Therefore I wanted to get other opinions on this as It didn't make sense to me why we would not bill for the consult.... and we are general and colorectal surgeons.

  7. #7
    Location
    Milwaukee WI
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    Default -57 modifier
    I believe you can use the -57 modifier on 992xx (admit to observation) codes.

    Please NOTE ... just because the patient was discharged in 24 hours does not mean that the physician admitted the patient to observation. Sometimes the patient is admitted as an inpatient but does so well post-op that s/he is discharged quickly.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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