# E/M- OBS and Inpt CPT codes



## cld (Aug 14, 2008)

The doctors are admitting the patients to the hospital with an inital OBS code-99220, followed by OBS sub. visit codes- 99214. Two or three days later, they change the status to an Inpatient code-99222 or 99223. I have been told by the practice manager the Inpatient and OBS codes can't be mixed on a continuous hospital visit, so I am having to go back and change the OBS admit and OBS sub visit codes to an Inpatient admit-99223 and an inpatient sub visit code-99232. Is this correct? Does the level of severity on the OBS codes stay the same on the Inpatient codes? Example: 99220 same as 99223; 99214 same as 99232. Also if an OBS admit stays less then 23 hours, it must be changed to an admit/discharge same day-99235. How do I determine the level of severity, by the H&P or the D/C summary.

Thanks for your help.
cld


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## lavanyamohan (Aug 15, 2008)

cld said:


> The doctors are admitting the patients to the hospital with an inital OBS code-99220, followed by OBS sub. visit codes- 99214. Two or three days later, they change the status to an Inpatient code-99222 or 99223. I have been told by the practice manager the Inpatient and OBS codes can't be mixed on a continuous hospital visit, so I am having to go back and change the OBS admit and OBS sub visit codes to an Inpatient admit-99223 and an inpatient sub visit code-99232. Is this correct? Does the level of severity on the OBS codes stay the same on the Inpatient codes? Example: 99220 same as 99223; 99214 same as 99232. Also if an OBS admit stays less then 23 hours, it must be changed to an admit/discharge same day-99235. How do I determine the level of severity, by the H&P or the D/C summary.
> 
> Thanks for your help.
> cld



Sorry. You are not supposed to mix outpatient and inpatient codes. This leads to HPMP errors. 
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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## Lisa Bledsoe (Aug 15, 2008)

cld said:


> The doctors are admitting the patients to the hospital with an inital OBS code-99220, followed by OBS sub. visit codes- 99214. Two or three days later, they change the status to an Inpatient code-99222 or 99223. I have been told by the practice manager the Inpatient and OBS codes can't be mixed on a continuous hospital visit, so I am having to go back and change the OBS admit and OBS sub visit codes to an Inpatient admit-99223 and an inpatient sub visit code-99232. Is this correct? Does the level of severity on the OBS codes stay the same on the Inpatient codes? Example: 99220 same as 99223; 99214 same as 99232. Also if an OBS admit stays less then 23 hours, it must be changed to an admit/discharge same day-99235. How do I determine the level of severity, by the H&P or the D/C summary.
> 
> Thanks for your help.
> cld



If a patient is admitted to inpatient status after a observation stay and does not leave the hospital, you code the observation admit for the first day of obs, subsequent obs as appropriate.  When the doctor decides to make the patient an inpatient, you code inpatient admit for the day the status changes.  The only thing different you should do is submit separate claims...on for the obs status and a new one for the inpatient status.  Never go back and change codes to inpatient if the status was obs.  Reference page 12 of CPT Professional Edition.  

As for the same day admit/dc codes - they are only used if the admit and dc occur on the same DATE.  Otherwise you use 99218 - 99220 for the first DATE and 99217 for the second DATE.  If reporting 99234 - 99236 ALL of the documentation shoudl be considered.  Reference page 13 of CPT Professional Edition.


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## AnnetteH (Nov 25, 2008)

*Obs*

Isn't it true that if the patient is in OBS less than 8 hours then 99218-99220 would be billed with no discharge


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