# VERY URGENT HELP:OBS E&M with G0378



## dinaraju06 (Jan 6, 2018)

Hi Friends,

A Good Day!

Can anybody please confirm whether we can code obs E&M codes (99218 series) and G0378/G0379 together for medicare/commercial payers?Any supportive document available?

Regards

Dina


----------



## eutsler (Jan 8, 2018)

Seems like double-dipping for any plans that cover the G codes. Medicare does not, the G0378 & G0379 are assigned status X, Statutory Exclusion.


----------



## thomas7331 (Jan 8, 2018)

G0378 and G0379 are codes for use by facilities for reporting hospital outpatient observation services on a UB claim form - these are not physician codes and are not reimbursed on the Medicare physician fee schedule.  I don't know of any non-Medicare payers that use these codes to reimburse physician/professional E&M services.


----------



## dinaraju06 (Jan 8, 2018)

thomas7331 said:


> G0378 and G0379 are codes for use by facilities for reporting hospital outpatient observation services on a UB claim form - these are not physician codes and are not reimbursed on the Medicare physician fee schedule.  I don't know of any non-Medicare payers that use these codes to reimburse physician/professional E&M services.



Thank you for your reply Thomas.

So you mean to say that the facilities have to use 'only' the G codes for reporting the observation services if the patient is under Medicare policy?.They don't have to use the O/P obs E&M codes right?.But for physician/professional services we can use the e&m codes.Am I right?

Regards

Dina


----------



## dinaraju06 (Jan 8, 2018)

eutsler said:


> Seems like double-dipping for any plans that cover the G codes. Medicare does not, the G0378 & G0379 are assigned status X, Statutory Exclusion.



Thank you Eutsler for your reply.

I am sorry can you please explain what is this statutory exclusion?I am sorry I am new to this


----------



## CodingKing (Jan 9, 2018)

The medicare Physician Fee Schedule database has an RBRVS status indicator. X means that is not considered a physician service

https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00004345

RBRVS Status:

*X* = Statutory exclusion. These codes represent an item or service that is not in the statutory definition of
"physician services" for fee schedule payment purposes. No RVUS or payment amounts are shown
for these codes, and no payment may be made under the physician fee schedule
(examples are ambulance services and clinical diagnostic laboratory services).


----------



## dinaraju06 (Jan 10, 2018)

CodingKing said:


> The medicare Physician Fee Schedule database has an RBRVS status indicator. X means that is not considered a physician service
> 
> https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00004345
> 
> ...



Thank you so much Coding King

So let me say.correct me if am wrong.For medicare,for facility  we should use G codes for observation and we should not use Obs E&M and for commercial payers we should not use G codes and only use E&M OBs codes.

Am I right?


----------



## dinaraju06 (Jan 10, 2018)

*Private room charges medicare*



dinaraju06 said:


> Thank you so much Coding King
> 
> So let me say.correct me if am wrong.For medicare,for facility  we should use G codes for observation and we should not use Obs E&M and for commercial payers we should not use G codes and only use E&M OBs codes.
> 
> Am I right?



Hi dear,
A Good Day!

I have a patient who stayed in private room for 3 days as inpatient(private room only facility).How could I bill the room charges .I have the rev code 0110 in built in our system.So I have to give 3 in quantity column (0110*3)as the patient stayed for 3 days?

Please help

Regards

Dina Raju


----------



## CodingKing (Jan 11, 2018)

dinaraju06 said:


> Thank you so much Coding King
> 
> So let me say.correct me if am wrong.For medicare,for facility  we should use G codes for observation and we should not use Obs E&M and for commercial payers we should not use G codes and only use E&M OBs codes.
> 
> Am I right?



It depends on the payer, many have adopted medicare guidelines




dinaraju06 said:


> Hi dear,
> A Good Day!
> 
> I have a patient who stayed in private room for 3 days as inpatient(private room only facility).How could I bill the room charges .I have the rev code 0110 in built in our system.So I have to give 3 in quantity column (0110*3)as the patient stayed for 3 days?
> ...



Yes, quantity is where the number of days goes. 0110 is for private room. 2 bed is 0120, 3-4 beds is 0130, Private Deluxe(?) is 0140. Some other rev codes are used based on bed type so its hard to tell if 0110 is correct or not.


----------

