ED Coding and Reimbursement Alert

Question: I am having trouble with a claim for multiple-day observation care. The ED physician admitted the patient at 8 a.m. Monday and performed a level-two observation. The patient stayed in observation all of Tuesday morning, and the physician released her at noon on Tuesday. How many observation codes should I report for this encounter?


Michigan Subscriber

Answer: You should report observation services for each day the ED physician treated the patient. If that time spans two days, you are correct to report two codes.

Caveat: EDs have to back up these claims with notes proving the days of observation. Make sure the documentation clearly demonstrates that your physician provided observation services on two different days. Linking each observation code with its date of service is the best way to prove the services.

On the claim,

- report 99219 (Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity) for the first day of observation. On the claim, make sure you note the calendar date that the patient received 99219 services.

- report 99217 (Observation care discharge day management) for the day the physician released the patient from observation. On the claim, make sure you note the calendar date that the patient received 99217 services.

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems Inc., an ED coding and billing company in Stoneham, Mass.