Oncology & Hematology Coding Alert

Question: Please tell me if it is appropriate to use observation care E/M codes if a patient is admitted for a 23-hour observation to receive chemotherapy. If not, under what circumstances should I use these codes?

Nevada Subscriber

Answer: Use codes 99234-99236 (Observation or inpatient hospital care) when the patient is under observation for a minimum of eight hours and discharged on the same calendar day. These codes are appropriate when the patient's care lasts between eight (8) and 23 hours. If the patient is admitted to observation on one day and discharged on a different calendar date, then use 99218-99220 (Initial observation care) with discharge code 99217 (Observation care discharge).

If a patient is admitted to the hospital as an observation patient to receive chemotherapy, the physician would bill for initial observation care based on the level of service provided, eg., 99218-99220. If the decision to admit the patient began in any other site of service for example, the emergency department all E/M services provided by the supervising physician that day are considered part of the initial observation care.

If the patient is discharged on the same date he was admitted to observation status, no other E/M charge can be billed. If the patient is discharged on another date than the day of admission, then you may appropriately bill 99217. Remember that 99217 includes all services provided on the date of discharge from "observation status" including final examination of the patient, discussion of the hospital stay, discharge instructions, and preparation of discharge records.