ED Coding and Reimbursement Alert

 Find flaws before you drop the claim - and keep your reimbursement intact

If the details of reporting observation care in the ED send you running from codes 99234-99236, tame your confusion with these helpful hints about exactly what information you need - and don't need - to bill OBS with ease.

  Do report observation care wherever the emergency department physician provides it - even if the patient stays in the same bed in the ED. No guidelines require that the patient be in the hospital's designated observation unit for the doctor to render this care.

  Do remember that the diagnosis does not affect physician payment for observation codes, as long as the physician documents the reason he felt observation care was necessary.

  Do remember that "same physician" means any physician in an ED practice who bills under the same group provider number, according to the CPT Panel and Medicare carriers.

  Do take global surgery rules into account when reporting observation care, because they apply with these codes (just as they do with any E/M service). You should still separately bill for any other procedures the physician provides in addition to the observation code, and append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

  Don't be finicky about time on the observation report, unless you're reporting same-day observation codes for Medicare - it's not the key component of this evaluation and management service. Time matters only when you're deciding whether to use same-day observation codes for Medicare, in which case the physician must have provided observation care for at least eight hours on that date. The amount of hours after that is not important unless the care extends into another day, and in that case, you'll switch to 99217 (Observation care discharge day management) and the 99218-99220 series (Initial observation care).

  Don't use a separate observation chart, unless your local carrier specifies otherwise. Many Medicare carriers don't require a separate observation chart, so as long as the physician documents providing observation care, the ED chart will suffice.

  Don't append modifier 21 (Prolonged evaluation and management services) to observation codes or report prolonged service codes (99354-99359) in the emergency department for observation care.

 - Tips provided by James Blakeman, vice president of Emergency Groups' Office in Arcadia, Calif.