Observation codes are not admit codes. So also, subsequent hospital care codes are not the same as clinic visit follow up for any patient.
When the patient is admitted to Observation, we opt a code from 99218-99220 depending on the severity mainly.
If observation extends beyond 48 hours, office visit follow up codes like 99213, are given.
When the patient is discharged from Observation we code 99217.
Observation codes are billed as outpatient.
If on the same day of admission to the observation, a patient is discharged codes 99234-99236 are opted.
But a minimum of 8 hours of service and time to time reporting is mandatory. These are also billed as outpatient.
Mostly, the MDM level based on severity as per the documentation, followed by a detailed or comprehensive history level should mark the code. Clinical visits are not supportive with such a descriptive MDM and/or history.
Ex: 1. An ESRD patient cannot be billed for observation.
2. A patient under acute asthmatic attack unresponding to nebulizer, requiring ventilator support- can be under observation initially and then moved to inpatient status depending on the severity of the presenting condition under treatment.
If on the same day of admission to observation, there is a clinic visit, code the Observation only.
If on the same day of discharge from the Observation, the patient is admitted to an inpatient facility, for further investigations, code only the inpatient admission 99221-99223.
For subsequent hospital care, give 99231-99233 codes. Dont mix up these codes with Observation codes, as these are very imporatant for further investigations. Clinical investigations are very minor and limited compared to these hospital subsequent care codes. This may create a chaos in billing due to the occurence of HPMP errors, i.e., outpatient billed as inpatient and claims getting rejected.
Hospital inpatient discharge codes are separate and time based. On the day of discharge from Inpatient facility, if there is a subsequent hospital care code, give only the subsequent hospital care code 99231-99233, for a better payment.
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