ED Coding and Reimbursement Alert

Question: We had a patient seen in the ED at  8 p.m. one day, admitted to observation at 2 a.m. the following morning, and discharged later that second day. What is the correct way to code patient care that spans two dates of service?

New Mexico Subscriber Answer: If the patient's admission to observation care takes place after midnight, you should report the appropriate emergency department E/M code for the first day's care (pre-midnight), and for the second day's care (post-midnight) you'll report one of the following codes:
  99234 - Observation or inpatient hospital care, for the evaluation and management of a patient include admission and discharge on the same date, which requires these three key components: a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision-making that is straightforward or of low complexity
  99235 - ... a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity
  99236 - ... a comprehensive history, a comprehensive examination, and medical decision-making of high complexity. Alternative: Suppose the physician admitted the patient to observation at 10 p.m. instead of 2 a.m. - meaning he provided some observation care on the first day. Because CPT instructs you to roll other E/M work on the same day into observation codes, a 10 p.m. admission to observation would leave you with observation service that spans two days.
 
In this case, you would report the first day's service with the 99218-99220 series (Initial observation care, per day, for the evaluation and management of a patient) and 99217 (Observation care discharge day management) for the discharge on the second day.