ED Coding and Reimbursement Alert

Question: A 65-year-old patient with significant airflow limitation due to chronic bronchitis and emphysema is admitted to observation for acute bronchitis. The ED physician performs a comprehensive history and a comprehensive examination along with medical decision-making of high complexity, the ED physician decides to admit the patient to observation status. Initially, the saturation is satisfactory and the physician starts the patient on antibiotics and bronchodilators by inhalation.

After spending 8 hours in observation from 10 AM to 6 PM, the patient's condition begins to deteriorate, the O2 saturation falls and the emergency physician decides the patient needs to be admitted to the hospital. The emergency physician contacts the patient's PMD for admission to the hospital. Is this an observation service?

Kentucky Subscriber

Answer: On the claim, report 99236 (Observation or inpatient hospital care visit for the evaluation and management of a patient, including admission and discharge on the same date, which requires these 3 key components; a comprehensive history; a comprehensive examination; and medical decision making of high complexity) for the initial evaluation with 491.22 (Obstructive chronic bronchitis; with acute bronchitis) to describe the acute bronchitis.

Explanation: A physician admits a patient to observation when they are still trying to figure out whether the patient's condition requires extended treatment in an inpatient setting. This patient was admitted to the hospital after the observation service was completed and they were discharged from observation so that the PMD could initiate the inpatient admission.

Keep in mind that CMS requires 8 hours of care for the same day admit and discharge observation codes.