ED Coding and Reimbursement Alert

Remember to leave 99217 off these claims.

Observation coding conventions call for a code from the 99218-99220 (Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: ... ) code set for patients in the first day of observation if the service spans more than one calendar date.

You should also call on these codes for certain single-day observation stays.

When? If you are coding for a Medicare payer, opt for 99218-99220 when the observation lasts less than eight hours on the same calendar date, confirms from Jill M. Young, CPC, CEDC, CIMC, founder of Young Medical Consulting, LLC in East Lansing, Mich.

According to Medlearn article MM5791 "Physicians and qualified NPPs should report Initial Observation Care using a code from CPT code range 99218-99220 when the observation care is less than 8 hours on the same calendar date.

When you report the 99218-99220 codes for observation services lasting less than eight hours, be sure you do not also report the 99217 discharge code. In order to report 99217, the discharge must occur on a different calendar date as the admission.

"Physicians and qualified NPPs should not report an Observation Care Discharge Service (CPT code 99217) when the observation care is less than 8 hours on the same calendar date," MM5791 reads.

Note: If the Medicare patient is admitted to observation and remains for more than 8 hours before being discharged on the same calendar day, a code from the 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: ...) observation set would be appropriate.