Internal Medicine Coding Alert

Question: The internist met an established 40-year-old male patient, who was complaining of chest pain, at the hospital. The internist puts the patient in observation on a Thursday evening to make sure he has not suffered an MI. Notes indicate a comprehensive history, a detailed exam, and straightforward medical decision making. The next morning, the internist discharged the patient with a diagnosis of rapid heartbeat. Would I use 99217 for the discharge day?

New Mexico Subscriber

Answer: Yes, you'll use 99217 (Observation care discharge day management) for the discharge date, since the patient was in observation for more than one calendar date. When coding these encounters, append the initial date of service to the initial observation service code (99218-99220). On this claim, you'd report the following:

99218 -- ... a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity ...) for the initial observation service;

99217 -- for the discharge service, and

785.0 -- Tachycardia, unspecified, appended to 99218 and 99217 to represent the patient's rapid heartbeat.

Keep in mind the following rules, from the Medicare Claims Processing Manual, Chapter 12, Section 30.6.8 (www2.cms.gov/manuals/downloads/clm104c12.pdf), when considering coding for observation care discharge services:

When a patient receives observation care for less than eight hours on the same calendar date select a code from CPT code range 99218-99220 (Initial Observation Care). Do not report CPT code 99217 for this scenario.

When a patient receives observation care for a minimum of eight hours, but less than 24 hours, and is discharged on the same calendar date, select a code from CPT code range 99234-99236 (Observation or Inpatient Care Services). Do not also report 99217 forthis scenario.

When a patient is admitted for observation care and then is discharged on a different calendar date, report a code from CPT code range 99218-99220 and 99217.