Oncology & Hematology Coding Alert

Question: A pancreatic cancer patient from our practice reported to the hospital with severe anxiety, abdominal pain, vomiting, and traces of blood in the vomitus. The hospital admitted the patient for observation and treatment on Monday morning, but he was not discharged until Tuesday morning, after the oncologist provided level-three observation services. How should I report this encounter?


New Jersey Subscriber

 
Answer: In this scenario, you can report an observation code and a discharge code.

On your claim, you should:

report 99220 - Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of high severity, for the observation care.

report 99217 - Observation care discharge day management, for the discharge.