ED Coding and Reimbursement Alert

Question: I have an op report in front of me that indicates two of our group's physicians provided observation services for the same patient on the same day. Physician One performed a level-two observation in the morning, and Physician Two performed a level-three observation later that afternoon. Can I report both observations?


Indiana Subscriber

Answer: No, you cannot. When a pair of doctors in the same ED group provide observation service to the same patient, you-ll have to choose one code. In this instance, you-re probably best served to report the higher-level observation for Physician Two.

On the claim, report 99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity) for the ED encounter.