ED Coding and Reimbursement Alert

Question: A patient is held in the ED overnight to be watched and re-evaluated by a psychiatric team for possible admission to a psychiatric hospital, i.e., suicidal intention, 72-hour watch. A different doctor and staff make the discharge decision and continue care ordered on a different day. Should we code this with 99217?

Patti Prentiss
Shayegan Medical Administration Inc., Encinitas, Calif.

Answer: The definition of 99217 reads, observation care discharge day management (this code is to be used by the physician to report all services provided to a patient on discharge from observation status if the discharge is on other than the initial date of observation status. To report services to a patient designated as observation status or inpatient status and discharged on the same date, use the codes for observation or inpatient care services).

This means that, observation care discharge of a patient from observation status includes final examination of the patient, discussion of the hospital stay, instructions for continuing care and preparation of discharge records. The discharge has to be other than the initial date of observation status.

As published in the Nov. 1, 2000, edition of the Federal Register, the revised national Medicare policy for observation care services changes how 99217 is used:

When a patient is admitted for observation care and discharged on a different date (24 hours or more), codes 99218-99220 should be used to report the admission, and code 99217 (observation care discharge day management) should be used to report the discharge.

You should use the observation codes. However, when billing these codes it is important to use the ones that apply to the service you gave. If a second group of doctors is discharging the patient from observation on a different date, then, yes, 99217 is correct for the ED physicians.

For more information on correctly using the observation care codes, see CPT 2001: Medicare Revises Observation and Inpatient Hospital Care Payment Policy in the January 2001 ED Coding Alert, page 1.