Question: I have trouble figuring out how to charge for a patient that was in observation, then admitted to the hospital, and then discharged. How would I report: observation on 8/20/11, admitted 8/21/11, and discharged 8/22/11? Also, do list place of service as in-patient or observation? Answer: If an observation patient is admitted to inpatient status by the same practitioner on a subsequent day, you may bill as follows, according to Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, director, Best Practices-Network Operations at Mount Sinai Hospital in New York City: Remember: CPT does not include a code for hospital admission itself. You'll bill 99221-99223 for the admitting physician for the physician's care if he documents the elements contained within the codes (appropriate history, exam, and medical decision-making). You are not billing for the admit itself, but rather billing for the care that your physician provides, based on the documentation.
Bill the observation using an initial observation care code (99218-99220, Initial observation care, per day, for the evaluation and management of a patient ...). The place of service should be 22 (Outpatient hospital).
Bill the discharge management service using 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (... more than 30 minutes), depending upon the time your physician spent on the patient's discharge. Again, use place of service code 21.