Ob-Gyn Coding Alert

Timing is everything when choosing a code.

When your ob-gyn admits a patient to observation, you’ll need to pay close attention to his date and time of service notes to ensure you code correctly. Timing matters for observation coding. Plus, if you separately bill for discharge management every time, you’ll soon land your physician in hot water.

Take a look at this expert advice to avoid these pitfalls and stop miscoding observation services.

Caution: The following rules for coding observations are for Medicare, and payers that follow Medicare policies. “Practices need to check with third-party payers to determine if they follow Medicare guidelines for observation,” advises Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pa.

Use 99218-99220 For Initial Day

There are two observation code sets, and which set you choose will depend on the encounter.

Employ the observation code set 99218-99220 (Initial observation care, per day, for the evaluation and management of a patient ...) in the following instances:

1. When a physician admits a patient for observation care, and then discharges him on a different calendar date, you’ll report a code from the 99218-99220 range for the first date of service, confirms Falbo.

Example: A doctor admits a pregnant patient who was in an automobile accident to observation at 5 p.m. Monday, even though the patient doesn’t seem to have any problems. The physician decides to keep her in observation overnight. On the claim, you’ll report a code from the 99218-99220 range for this initial service, depending on encounter specifics.

2. When the physician admits and discharges a patient from observation care in less than eight hours on the same calendar date, you’ll also employ 99218-99220, confirms Falbo.

For example, your physician admits a different patient with a history of kidney stones and frequent urinary tract infections who is having flank pain to observation at 6:30 a.m. Monday. The physician then discharges the patient at 12:13 p.m. that day. Since this service was less than eight hours, choose a code from 99218-99220 for the observation.

Take note: You’ll need to make sure that the physician who admits the patient for observation is also the one that cares for the patient during his stay, Falbo says. If he is not the physician admitting the patient for observation but does see the patient while he is in observation, do not code for an observation service of any kind, but rather use an outpatient code from the 99201-99215 family of E/M codes.

Change Coding When 1-Day Observations Hit 8 Hours

If the physician provides a single-day observation service that lasts more than eight hours on the same calendar date, your coding choices change, confirms Falbo.

For these longer single-day observations, choose from the 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ...) code set.

Example: A patient presents to the emergency department (ED) at 9 a.m. Thursday and the provider admits her to observation care an hour later. The physician discharges her at 8 p.m. that evening. Since the visit exceeded eight hours, you should report a code from the 99234-99236 range, depending on encounter specifics.

When the length of stay is eight hours or longer, providers should report codes 99234-99236 for Medicare, says Falbo. “However, CPT^® does not mention the minimum time requirement, and states that providers may use these codes as long as the admission and discharge occur on the same date of service.”

Best bet: Once again, always check with private payers before coding for these observation services — as they might not all follow Medicare’s prescription for these codes.