# Observation



## NESmith (Jan 18, 2011)

What if anything is your take on patients being kept in Observation status longer then the 24-48 length of stay? I am under the understanding that some facilities are keeping patient as long as 3 to 4 days as Observation. Am I missing something here?


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## fredabrinson (Feb 18, 2011)

*Physician Ordered*

Observation status is not determined by a facility; it is directed by the physician's order.  Most facilities have Case Management / Clinical Documentation Specialists who review the medical records real time and converse with the physicians regarding the medical necessity of the patient.  However the bottom-line is that a physician's order is the determining factor for observation vs. inpatient status.  If the medical necessity of the patient's condition does not meet inpatient criteria but the patient is not able to be discharged, there is no other choice than to continue the patient in observation status.  This status does impact the Medicare payment a facility receives, but the physician will be paid per E&M billed.  As you know, AMA did add new E&M codes for observation services for 2011, and these codes are payable under the MPFS.


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## Patricia L Diaz (Feb 19, 2011)

the new codes are out of numerical sequence...I believe they are @ 99224 code range...sorry at hm with no book and no notes...


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