ED Coding and Reimbursement Alert

Question: How should I bill the following scenario?: A patient was admitted to the ED at 8 p.m. and admitted to observation at 2 a.m. on the calendar date following the ED visit. The patient was discharged later on the second day. The same ED physician worked the shift from 6 p.m. the first day to 6 p.m. the second day.

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Answer: This is an uncommon scenario because of the observation care's timing. The patient comes to the ED very late at night, and then after midnight the physician realizes that the patient's clinical condition has not improved enough for him to be discharged. He then makes the decision to admit the patient into observation. An example would be an asthmatic who comes in at 8 p.m. and receives steroids and multiple nebulizers. Six hours later, the physician realizes the patient has persistent wheezing and decides to admit him to observation. The patient stays from 2 a.m. until 4 p.m. when the physician discharges him. You should assign the appropriate ED E/M code (99281-99285) for day one and the appropriate observation care code (99234-99236) for day two. Of course, you must meet the documentation requirements, including a new history and physical, to bill the observation code.

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