Choose Observation Code Based on Length of Patient Stay
Published on Tue Apr 10, 2007
Learn to ID observations, which pay about 60 percent more than E/Ms
When your ED physician performs observation services, you must be ready to differentiate between the two types of observation codes. For the most spot-on claims, coders also need stellar documentation from encounter forms so they can choose the proper procedure and diagnosis codes.
Further, failure to differentiate observation services from standard evaluation and management services will hurt your practice's bottom line. For level-two observation code 99219, Medicare pays about $99.67, says Caral Edelberg CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth, Jacksonville, Fla. For level-two ED E/M code 99282, Medicare pays about $37.14, Edelberg says. Code First Day of Stay With 99218-99220 The first of the two observation code sets you-ll use is the 99218-99220 family: Report these codes for the first day of observations that span more than one calendar date, Edelberg says.
-These observation admission codes are reported only by the supervising or attending physician when the patient is admitted to observation. These codes include initiation of observation status, supervision of the care plan for observation, and performance of periodic reassessments,- she says.
Example: A male patient presents to the ED at 6 p.m. with a moderate asthma exacerbation. After two hours of nebulizer treatments, the patient has mildly improved but is not safe for discharge. The ED physician admits the patient to observation status at 8 p.m., hoping to forego the need for inpatient admission with additional nebulizer treatments. The patient receives additional nebulizer treatment overnight.
In the morning, the respiratory rate is noted to be normal, and the patient's wheezing has subsided. The ED physician writes a discharge order at 7 a.m.
On the claim, you would:
- report 99220 (Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity) for the observation.
- link 493.92 (Asthma, unspecified; with [acute] exacerbation) to 99220 to represent the patient's asthma. Remember to Note Physician Involvement in Your Observation Documentation On your 99218-99220 claims, include proof that the patient was in the care of the ED physician during the observation period. You can prove this with notes in the medical record -for admission, discharge, and other appropriate progress notes that are timed, written, and signed by the physician,- says Marianne Wink-Sturgeon, RHIT, CPC, ACS-EM, at New York's University of Rochester Medical Center.
The medical record must include documentation showing that the physician explicitly assessed patient risk to determine that the beneficiary would benefit from observation care.
-Also, documentation must support the level of service charged,- Edelberg adds. For example, if the physician reports 99220, your documentation must support a medically [...]
