EM Coding Alert

Question: I have a question about obstetrical patients in observation status. If a patient is under observation for more than one day (say 11/11 to 11/12) and discharged out of observation on 11/12, what codes should I bill? We share call with another provider and are trying to figure out who bills for what. Sometimes they put my patients in observation, dictate an H&P, etc. Then the next day my doctor sees the patient and discharges her out of observation. What should I do?

North Carolina Subscriber

Answer: While CPT^® is silent about subsequent observation and discharge services on the same date of service, you cannot bill an initial observation/hospital visit and discharge separately when they occur on the same date of service. So, it makes sense that the intent is to bill only for discharge if it is on a separate date of service than the admission, whether by another MD or the same MD. The discharge code would be 99217 (Observation care discharge day management ...). The discharge code includes the following services:

• Final examination of the patient;
• Discussion of the hospital stay;
• Instructions for continuing care; and
• Preparation of discharge records.

If this is what has been documented, then you should bill only the discharge. While you will see an initial admission and same date discharge observation code, this would not apply to the situation you are describing.