Oncology & Hematology Coding Alert

Question: I saw that you should use 99234-99236 for observation between eight and 24 hours on the same date for Medicare. Does that mean you can’t report observation that lasts less than eight hours on a single day?

Tennessee Subscriber

Answer: For observation lasting less than eight hours on a single date, you should report the appropriate code from 99218-99220 (Initial observation care, per day, for the evaluation and management of a patient …). You should not report discharge code 99217 (Observation care discharge day management). Medicare spells this out in Medicare Claims Processing Manual, Chapter 12, Section 30.6.8 (www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf).

Documentation tip: The manual advises that to support reporting an observation code, the medical record should include the physician’s dated and timed order for the observation services and progress notes during the observation time.