# Hospitalist OBS vs Inpt Acute



## sasharea (Feb 23, 2011)

Pt was admitted through the ED on 02-09-11 to OBS and changed to Acute on 02-11-11. Would we bill an OBS code (99218-99220) for 02-09-11? Following day 02-10-11, would we code that as subsequesnt OBS (99224-99226)? or would we code an OBS discharge (99217)? Then for 02-11-11 should we be coding an intake to acute (99221-99223)? or follow-up (99231-99233)?
If anyone could provide me with more information that would be greatly appreciated. Thanks so much for all the help!


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## dwaldman (Feb 23, 2011)

"If the patient is admitted to inpatient status from hospital outpatient observation care subsequent to the date of initiation of observation services, the physician must bill an
initial hospital visit for the services provided on that date. The physician may not bill the hospital observation discharge management code (code 99217) or an outpatient/office visit for the care provided while the patient received hospital outpatient observation services on the date of admission to inpatient status."

https://www.cms.gov/manuals/downloads/clm104c12.pdf
page 50

I looked at Sept 2010 CPT Assistant and the CMS claims processing manual. This was the best excert I was able to find. I could not find where I have heard they say if for initial inpatient care does not meet a detailed history and detailed exam then 99231-99232 could be reported to be in accordance with the criteria to meet the given level even though it is an initial inpatient care.


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## dwaldman (Feb 23, 2011)

http://www.cms.gov/MLNMattersArticles/downloads/SE1010.pdf

Here the link I was referring to if the criteria did not meet 99221, 99231-99232 could be considered.


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## dwaldman (Feb 24, 2011)

Initial Observation Care


New or Established Patient

The following codes are used to report the encounter(s) by the supervising physician with the patient when designated as “observation status”.  This refers to the initiation of observation status, supervision of the care plan for observation and performance or periodic reassessments.  For observation encounters by other physicians, see Office or Other Outpatient Consultation codes (99241-99245) or subsequent observation care codes (99224-99226) as appropriate.

 To report services provided to a patient who is admitted to the hospital after receiving hospital observation care services on the same date, see the notes for initial hospital inpatient care (page 14).  For observation care services on other than the initial or discharge date, see subsequent observation service codes (99224-99226).  For a patient admitted to the hospital on a date subsequent to the date of observation status, the hospital admission would be reported with the appropriate Initial Hospital Care code (99221-99223).  For a patient admitted and discharged from observation or inpatient status on the same date, the services should be reported with codes 99234-99236 as appropriate.  Do not report observation discharge (99217) in conjunction with a hospital admission.

When "observation status" is initiated in the course of an encounter in another site of service (eg, hospital emergency department, physician's office, nursing facility) all evaluation and management services provided by the supervising physician in conjunction with initiating "observation status" are considered part of the initial observation care when performed on the same date.  The observation care level of service reported by the supervising physician should include the services relating to initiating "observation status" provided in the other sites of service as well as in the observation setting.

Evaluation and management services on the same date provided in sites that are related to initiating "observation status" should NOT be reported separately.

These codes may not be utilized for post-operative recovery if the procedure is considered part of the surgical "package."  These codes apply to all evaluation and management services that are provided on the same date of initiating "observation status."


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