Otolaryngology Coding Alert

Capture overnight minor-procedure complication with 99217

You ethically deserve $70 in observation discharge reimbursement as long as the visit isn't planned or related to a post-op period or a request for opinion.

Reserve Discharge for Zero-Day Procedure With Complications

When an otolaryngologist admits a patient overnight to observation for complications following an outpatient surgery with no global period, experts say you should report the discharge service with 99217 (Observation care discharge day management ...). But the encounter must meet these criteria:

1. The insurer assigns the procedure a zero-day global. "If the surgery has a 10- or 90-day global period, the surgical package includes any related E/Ms," says Christopher B. Felthauser, CPC, CPC-H, a PMCC Medical Coding Instructor with Orion Medical Services in Eugene, Ore. In this case, you would consider an observation care discharge (99217) part of the procedure's postoperative care.

2. The patient develops a complication, such as a temperature or bleeding, requiring observation. "If the otolaryngologist prospectively schedules a patient for overnight observation care following a particular procedure, you shouldn't charge a discharge service on day two," says Eileen Antico, CPC, an otolaryngology coding specialist at Nemours Clinical Management Program (12 otolaryngologists) in Orlando, Fla. The observation care services would be part of the procedure's normal postoperative care.

Bill Day-2 Discharge as 99217

Normal observation care services include an admission to observation status (place of service 22, Outpatient) and a discharge. But when you report observation care following an outpatient procedure, you should code only the discharge service (99217).

Do not report the admission. "Because the admission is directly related to the surgery, you would not bill 99218-99220 (Initial observation care, per day, for the evaluation and management of a patient ...)," says Juli M. Smith, practice administrator at NE Texas ENT Center.

Example: Because a complex nasal hemorrhage patient had extensive blood loss, an otolaryngologist admits the patient overnight to the local hospital's observation department. "You should bill the surgery (30903, Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing], any method) on day one, and observation discharge (99217, Observation care discharge day management ...) on day two," Smith says.

The physician's 99217 entry should detail the discharge services the otolaryngologist performs, such as final examination, instructions to patient and caregivers, and discharge documentation preparation. Medicare will pay 99217 at the national rate of $70.87. (The 2005 National Physician Fee Schedule assigns 99217 1.87 relative value units.)

Use Outpatient Consult Code for Opinion

Make sure you don't automatically report observation status with an observation care code. The treating physician may have asked the otolaryngologist's opinion regarding a patient's problem.

Scenario: An internist requests a consultation for a patient with parotitis (527.2). The otolaryngologist decides the patient does not need surgery at that time.

You should report the otolaryngologist's service as an outpatient consultation (99241-99245, Office consultation for a new or established patient ...), if the encounter meets a consultation's requirements of request for opinion, rendering of service, and report of findings. The internist charges for the observation services.

Catch: Even though the patient is in the hospital, you will still use outpatient consultation codes. CPT considers a patient in observation status an outpatient.