ED Coding and Reimbursement Alert

When coding observation services, knowing the proper code choice is often only part of the task. Even if you are schooled in the coding conventions for observation, you might find yourself with a question or two when it comes time to file your claim.

Check out these observation coding FAQs, and keep this list handy for your observation claims.

- What should I do if the ED physician provides observation service in a non-traditional setting, such as an ED hallway area? Code the service just as you would normally. Observation is a type of service, not a place of service.

- What happens if we don't have proof that the physician ordered the patient to observation? You must have proof of the physician order, or you cannot report an observation code. A time note from the doctor, and one from the nurse, should keep you covered.

- Can we report a related E/M service in addition to an observation service? No, you-ll have to choose an observation code or an E/M, and the proper choice will depend on the specific situation. But feel free to code separately for any non-bundled procedures or diagnostic tests the physician orders during observation.

- What if two physicians from the same practice provide observation care for the same patient? You can bill only one of the physicians- observation services. Payers won't accept observation claims from multiple physicians for the same patient episode.

- How should I report the middle day of a three-day observation stay? This is a rare occurrence, but if it happens, CPT instructs you to code the middle day with 99499 (Unlisted evaluation and management service).