Gastroenterology Coding Alert

Question: If a patient is admitted and discharged from observation status on the same day, can I report an observation care code and a discharge code?

New Jersey Subscriber Answer: No, you cannot. When a patient is admitted and discharged from observation status on the same day, use observation or inpatient care service codes - and do not code extra for the discharge service.

For example, a patient with chronic liver disease is seen in the emergency department on a Monday morning for abdominal pain and vomiting. The gastroenterologist meets the patient at the hospital, admits the patient for observation and treatment of dehydration, provides level- three observation care, and discharges her that afternoon.

Since the gastro admitted and discharged the patient on the same day, you should only report a single observation code.

On the claim, you should 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. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem[s] and the patient's and/or family's needs. Usually, the problem[s] requiring admission to "observation status" are of moderate severity) for the observation. Exception: But let's suppose that same patient with liver disease comes to the hospital with severe anxiety, abdominal pain, vomiting, and traces of blood in the vomitus. Again the patient is admitted for observation and treatment on Monday morning but is not discharged until Tuesday morning, after the gastroenterologist provided level-three observation services.

Since the admission and discharge are done on different dates in this scenario, you may report both codes. On your claim, you should:

 report 99220 ( ... a comprehensive history; a comprehensive examination; and medical decision- making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem[s] and the patient's and/or family's needs. Usually, the problem[s] requiring admission to "observation status" are of high severity) for the observation care.
 report 99217 (Observation care discharge day management) for the discharge.