# Oberservation in the ER



## jessicaparker1 (Feb 8, 2013)

Hi

I hopeing someone can help me clear a question: When a patient is placed in observation at 10pm and is not released until day 2 at 2am, can we bill 99220 day 1 and 99217 day 2? I've notice some of our outside coder billing this way and I just received a call from a patient stating we are double billing. I always question this but never received any denials and can not find anything in writing. If you have any feed back and websites that can support either way, it will help me dearly.

Thank You in advance


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## smcbay (Feb 8, 2013)

Do you have 2 seperate dictations?  One for H & P and a disccharge?


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## mitchellde (Feb 8, 2013)

is this for the facility or the physician?


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## jessicaparker1 (Feb 8, 2013)

henleyst said:


> Do you have 2 seperate dictations?  One for H & P and a disccharge?



Only 1 report from start to discharge.


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## jessicaparker1 (Feb 8, 2013)

mitchellde said:


> is this for the facility or the physician?



Sorry Physician.


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## jimbo1231 (Feb 10, 2013)

*Physician Side*

I'll take a crack at this. Medicare requires 8 hours. So if it is a Medicare patient or a plan that follows Medicare, there just aren't enough hours for Observation. If it is a non Medicare patient, you could have the option of billing both codes. But only two hours Observation on the first day isn't much time. My view is an ED level might be more appropriate here. But as always open to other views. But there is nothing inappropiate for coding both if you are not following care guidelines, just pushing the envelope a bit. And you are OK with the time if not Medicare. Guess it's a judgement call.

Jim S.


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## jwolf13721 (Feb 11, 2013)

When time is the diagnostic tool, and the chart is documented correctly, then yes, you may charge the observation codes.  Notation of the intial exam and time placed into observation "status" must be in the chart.  Supporting reasoning as to why patient was placed in observation ... ie alcohol level too high, or asthmatic with acute exacerbation, waiting on response to intervention.  Re-exams are not required, but document when they are done.  And a discharge note summarizing outcome, and time of discharge.  In PFSH, past medical, social and family history must be obtained in order to charge the observation.  You can charge the 99220 and the 99217 when discharge is other than on the day that observation was started.  Hope this helps


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## jimbo1231 (Feb 14, 2013)

*My Bad....*

Just wanted to clarify /correct my answer the above;

On the physician side the 8 hour requirement is only for same day admit /discharge. So the 8 hour rule would noy apply to the above example.

On the facility side the 8 hour rule applies for all Medicare claims since the G code is for total hours.

Just sat through a Novitas seminar on it. They do a nice job for free, not that AAPC doesn't do a very nice job, but not free.

I'm putting myself on guru probation.

Jim S


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