Cardiology Coding Alert

Question: I am very confused about billing observation charges. I know to submit one charge for less than 24 hours, but what if the patient was admitted at 11:00 p.m. one day and was discharged the following day at 10:00 a.m.? Would you bill for both days? Or should I just report the observation charge for the day of admit ? And what if the patient stays for more than 24 hours? Would payers consider that an inpatient stay? 


Kansas Subscriber

Answer: Because the hospital's definition of observation care can sometimes differ from your cardiologist's, coding can be confusing. But here's how to look at this service:

If your cardiologist admits the patient and discharges her on the same date to an observation status and the stay is longer than eight hours, then you should use 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ...). Note: You'll also need a dictated admit and discharge.

If your cardiologist admits the patient to an observation status on one day (99218-99220, Initial observation care, per day, for the evaluation and management of a patient ...) and then discharges her from observation status on a different calendar date (99217, Observation care discharge day management ...), you should be able to report both of these codes.

On the rare occasion when your cardiologist admits a patient to observation status and discharges her after more than two days in observation, you should report the observation admission service and the observation discharge service as described above. Keep in mind: For the days in between these admit/discharge dates, you should report outpatient care codes (such as 99211-99215). When your cardiologist anticipates that a patient will need more than 24 hours of skilled nursing care, however, your cardiologist should be admitting the patient to inpatient status rather than observation.