ED Coding and Reimbursement Alert

Question: If you have a patient that presents to the ED with suicidal tendencies and the ED physician wishes to admit the patient to observation status, then consults a social worker or psychologist, can the ED physician still bill for the observation even if the social worker stays on the premises to observe the patient? The patient is still under the medical direction of the ED physician. I feel that we can still bill for the observation services.

Sharon Kowalzyk,
General Medical Services, Kingston, PA

Answer: You are correct, says Stradley. The ED physician is in control of the patient and, as long as he is actually checking periodically on the patient and is the one who will be responsible for the discharge, then he should bill the observation service (99218-99220). Although the social worker is observing the patient, it seems as though the observation would be just in relation to mental status and not the overall care of the patient.