ED Coding and Reimbursement Alert

Question: For observation time for professional services, do you use the 99218-99220 series if the patient presents at 10:00 p.m. to the ED and is assigned to observation at 3:00 a.m. with a discharge at 12:30 pm? Or, do you default to a level of service?

Virginia Subscriber

Answer: CPT® is clear that when observation services are initiated in the course of another E/M encounter by the same provider on the same date, you should include the work associated with the decision to admit to observation in the observation code reported.

In this case, the patient is first seen in the ED late on the prior day and admitted to observation status very early the next morning, which is a different date of service. If chart documentation supports the medical necessity and required key components, you could report the appropriate ED E/M code on day one and the appropriate observation code on day two. In this case you would choose from the code set 99234-99236.