ED Coding and Reimbursement Alert

Question: A patient presented to the ED complaining of chest pain at 8 a.m. The physician examined the patient and, finding no definitive cause for the condition, placed the woman in observation at 9 a.m. At 7 that night, the physician decided the patient could be discharged. Which observation code should I use?

Arkansas Subscriber
 
Answer: Since the patient was admitted and discharged on the same date, you should choose the appropriate code from the range 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ...) based on the documentation provided.
 
In 2001, CMS  indicated that use of the same-day observation admit/discharge codes 99234-99236 for Medicare patients must involve lengths of stays of at least eight hours. For stays of less than eight hours, use codes from the initial observation series 99218-99220 (Initial observation care, per day, for the evaluation and management of a patient ...).

 - Reader Questions and You Be the Coder were reviewed by Mike Granovsky, MD, CPC, FACEP.