Inpatient Facility Coding & Compliance Alert

Question: A 69- year-old with a mild acute exacerbation of obstructive chronic bronchitis is admitted to observation care by the pulmonologist for treatment. He responds to treatment and is discharged home on the next day. The patient was also seen by a cardiologist on the day of discharge, who also gives a diagnosis of hypertensive heart disease without heart failure.

How do I code for this scenario.

Wyoming Subscriber

Answer: Because of the documented complexity of his condition and decision-making, you code 99219 (Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity...) for the initial day, and 99217 (Observation care discharge day management) for the discharge day. This code is to be utilized to report all services provided to a patient on discharge from “observation status” if the discharge is on other than the initial date of “observation status.”

To report services to a patient designated as “observation status” or “inpatient status” and discharged on the same date, use the codes for Observation or Inpatient Care Services (including Admission and Discharge Services, 99234-99236 as appropriate.)

For the acute exacerbation of the obstructive chronic bronchitis you code J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation). The patient was also seen by a cardiologist on the day of discharge, assign the code 99204 (Office or other outpatient visit for the evaluation and management of a new patient...) for the visit and use ICD-10-CM code I11.9 (Hypertensive heart disease without heart failure) for his diagnosis of hypertensive heart disease without heart failure.

Pointer: Most observation services last one to two days at the most; after that much time, the physician will typically admit or release the patient. There might be instances, however, when a patient is in observation care for more than two calendar days. When this occurs, contact your payer before coding the service. You should use subsequent observation care codes (99224-99226) for the days between admission and discharge.