# observation to admit



## ssharp (Aug 13, 2013)

Our provider was consulted to the er and saw the pt for acute abdominal pain. Later that day he determined the pt had apendicitis. He then took to the pt to an or for surgery and the patient remained in observation over night and the next day was changed to a inpatient status. How would the e&m be best coded and would the original consult be considered in the global package. Please advise


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## jimbo1231 (Aug 13, 2013)

*Surgery*

Does this mean that the patient was on Observation status when they had the appendectomy? Seems unlikely they would be effectively an outpatient for an appendectomy. Are you certain the patient wasn't admitted for surgery on the first day? But if the patient was admitted to the hospital on the second day, Observation discharge would not be coded, the admit new hospital visit would be coded for the admit day. How long was patient in Observation status on the first day?
As to the consult, if it's Medicare you wouldn't use the consult code. But if the decision for surgery was made during that consult, I believe you can bill with the 57 modifier. But I'll throw that out to the group. And if it's a Medicare or other payor that does not recognize consults, I believe you'd follow the place of service for the first day and code an ED visit with a 57.


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## FTessaBartels (Aug 19, 2013)

*Most appys are outpatient*

These days most appendectomies are admitted as outpatient procedural short stay .... they are switched to inpatient only if perforation/peritonitis/abscess are found.

I'd have to read the documentation to determine if a -57 modifier would be appropriate for the first visit.  It seems likely, but without seeing all the documentation I can't really tell. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## jimbo1231 (Aug 20, 2013)

*Thanks*

Tessa,

Thank you for the clarification. I should have known better with the direction healthcare is moving. My sister is having a fairly major procedure soon and I think will be out in two days. What's next Heart Transplants in Ambulatory Surgery Centers? Probably, some day.

Jim


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