ED Coding and Reimbursement Alert

Question: Our doctor treated a patient in the emergency department (ED), and he admitted the patient to observation. He monitored the patient beginning in the later afternoon and then all night. The next day, a consulting physician admitted the patient to inpatient status. Should we code 99220 as well as 99217? The documentation definitely supports 99220, but I'm not sure whether to code them both.

Iowa Subscriber

Answer: Technically, the patient's observation stay spans two calendar days, so you would use code 99220 (Initial observation care) for the first day. For the second day, you could potentially report 99217 (Observation care discharge).
 
The services you provide for 99217 include a final exam, discussion of the observation stay, follow-up instructions, and documentation. If your physician provided these services, then 99217 would apply. If the admitting physician provided all the care on the second day though, 99217 would not apply.
 
Also keep in mind that all the services for the admitting doctor are rolled into the 99221-99223 series of inpatient admission codes, so make sure you report those when necessary.