ED Coding and Reimbursement Alert

'Middle day' observation codes are game changers for patients in observation 3+ days.Coders need to understand the new 99224-99226 observation codes soon, as reporting the "middle days" of observation services lasting three days or more will change on Jan. 1, 2011. To illustrate how to use the 99224-99226 observation codes, consider this detailed clinical example courtesy of Michael Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.A 62-year-old patient with dyspnea and chest pressure presents to the ED at 8 p.m. Saturday. The physician admits the patient to observation at 11 p.m. Saturday. During the patient's stay in the observation unit, the physician obtains a comprehensive history, which reveals increasing exertional dyspnea over the last three days, known coronary artery disease, a myocardial infarction (MI) two years prior and 2 episodes of congestive heart failure (CHF) in 2009.The physician performs a comprehensive multi-system [...]