ED Coding and Reimbursement Alert

8-hour mark is crucial for Medicare patients When your ED physician performs observation services, the code choice will depend on the number of days (or hours) the patient remains in observation. And once you arrive at the proper code, you-ll have to make sure the supporting documentation is in order before sending the claim off. You also need to make sure that the ED physician is actually providing the patient observation services before coding; often, what appears to be an observation is actually an ED E/M service. Check out this primer on coding the different types of observation services. ED E/M Typically Not Possible on Observation Claims For observation stays spanning more than one day, you will use 99218-99220 for the first day, says Joan Gilhooly, CPC, CHCC, president of Medical Business Resources LLC, in Deer Park, Ill. The physician uses 99218-99220 for the patient's initial day of observation, "unless the patient is admitted to observation and subsequently discharged all on the same calendar day," she says. These codes include all the E/M services the physician provides the patient that day (regardless of location). Therefore, you will not be able to separately report an ED E/M in most cases. Warning: Gilhooly recommends coders look out for extended ED services that might appear to be observations but really aren-t. Attempting to categorize everyone who requires lengthy treatment in the ED as an observation patient is not good coding practice. "By definition, someone is admitted to observation because you-re still trying to figure out whether they are sick enough to be admitted as an inpatient," Gilhooly says. Keep this in mind when deciding whether or not to report an observation code for your physician's service. Remember Discharge Code When Appropriate When the physician provides observation service to the patient over the course of more than one day, you should also report 99217 (Observation care discharge day management) to represent the service on the day of discharge, Gilhooly says. Do not include 99217 on observations that last a single calendar day; the service must span at least two dates before 99217 is appropriate. Example: A 48-year-old male with chronic obstructive pulmonary disease (COPD) presents to the ED with an acute exacerbation. Following the administration of nebulizer treatments and steroids, the patient is somewhat improved but not safe for discharge. The ED physician writes an order to admit the patient to observation at 9 p.m. The patient receives several additional rounds of nebulizers along with repeat physician assessments overnight. The next morning, the patient continues to stabilize, and a 6 a.m. blood gas shows significant patient improvement. The ED physician performs a final assessment at 7 a.m., which shows the patient is comfortable. The [...]