For subsequent observation days, use 99224-99226. On occasion, your neurologist could keep a patient in observation for more than two full calendar days. If she has to do this, you'll need to be ready with knowledge of a few fairly obscure observation codes. According to Medicare, the decision whether to discharge a patient from the hospital or admit the patient as an inpatient can be made in less than 48 hours, usually in less than 24 hours, says Todd Thomas, CPC, CCS-P, president of ERcoder, Inc. in Edmond, Oklahoma. Rarely does an observation span more than 48 hours. When, however, a patient is admitted to the hospital on day one, stays all of day two, and is discharged on day three, you'll report one of the following codes for the second day: You only need to satisfy two of the three key components for each code level, says Thomas. Caveat: You might want to give your insurer a heads-up before sending in this claim. Often, payers request that you include documentation as to why the patient was in observation for so long without being admitted to the hospital.