Wiki Facility observation coding in ED- commercial payer

[Iam2Code]

Hi all!

My boss says that code 99218 has to be added multiple times to get reimbursement (added once for every 30 min that the patient is observed) So let's say the patient was observed for 6 hours, according to her it must be added 12x. Makes no sense to me. Shouldn't the 99218 be coded just once in this case?

This is for facility coding. I have tried to show her the CPT description that says 'per day' but she says that's for physician billing. Do you guys know of any guideline that I could show her in regards to this? PLEASE advise!! Thanks.

 

[TThivierge]

Observation Codes CPT 99218 to 99226 Read CPT manual pg 14-15

Hello,

I believed this is wrong...check in CPT manual for codes and time periods then Google some info too. First the patient may start out in the ER visit should be billed, then proof doc put in observation status. The CPT 99218 is for initial observ. first day, use other observation CPT codes if patient remains in observation. Usually observation cannot be more than 72 hours (check the payer regulations and authorization if required) if so...patient could go next go to inpatient status or discharge from observation. Also if discharged from observation use the CPT code 99217. Ensure docs document this portion observation of patient blab blab and reason

Good luck!!

Lady T