Medicare Compliance & Reimbursement

1. Bill just one E/M visit: If your physician sees a patient in his office and decides to subsequently admit that patient to observation status, you cannot report both the office E/M (e.g. 99213) and observation code (e.g. 99218).

"If the provider sees the patient in the office and then sees the patient in observation, then the office visit rolls into the initial observation code," says Sherry Gann, CPC, with Shawnee Health Service.

2. Only use 99234-99236 for one-day visits: If your physician admits a patient to observation status and discharges the patient on the same date, report a code from the 99234-99236 range. "The physician should not report these codes when the patient is admitted one day and discharged the next day," according to the June 2002 CPT Assistant.

3. Bill for discharges performed on subsequent dates: If the physician sees a patient for observation care (such as 99220) and discharges him on a different date, you can bill 99217 (Observation care discharge) on the discharge date, says Rhonda Hardison, CPC, coder with the Head and Neck Center in Baton Rouge, La.

4. Watch for adjustment to inpatient status: "CPT instructs that once a patient is admitted you should no longer use the observation procedure codes; you should use the inpatient codes," says Kim French, CIRCC, of Crouse Radiology Associates in Syracuse, N.Y.