Cut Through the New Observation Care Coding Confusion
Published on Sun Mar 01, 1998
With managed care having an increasing say over how long patients can stay in the hospital, one-day hospital treat-ment, especially for observation, is growing more popular. It means a little extra work in terms of coding, however.
Managed care is overseeing all hospital admissions more closely, explains Charles M. Vanchiere, MD, FAAP, CEO of Childrens Clinic of SW Louisiana in Lake Charles. Therefore, pediatricians must be aware of two kinds of short-term inpatient codes: observation or inpatient care services which includes admission and discharge on the same date (the new codes), and hospital observation services (including one revised code). In addition, you may be using the familiar hospital discharge services if the patient was an inpatient instead of on observation status.
If it seems confusing, it is. Vanchiere, who chairs the AAPs RBRVS PAC, prepared a flow chart for PCA with the appropriate slot for each code (see chart below).
What the New Codes Are For
There are three new codes -- CPT 99234 , 99235, and 99236 -- for hospital care services provided to patients who are admitted and discharged on the same date of service. The three codes represent three levels. All three codes apply to either observation status or inpatient care services, and include admission and discharge. You cannot bill any other E/M codes for this day.
99234 is for observation or inpatient hospital care (admission and discharge on same date) requiring a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision-making that is straightforward or of low complexity. The presenting problem is of low severity.
99235 is for observation or inpatient hospital care (admission and discharge on same date) requiring a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity. The presenting problem is of moderate severity.
99236 is for observation or inpatient hospital care (admission and discharge on same date) requiring a comprehensive history, a comprehensive examination, and medical decision-making of high complexity. The problem is of high severity.
Frequently, observation status is initiated in the pediatricians office. For example, the child may need to go to the hospital for rehydration, to check for a rebound reaction after inhalation therapy, or for croup. When this occurs, all evaluation and management services provided in conjunction with this are part of the initial observation care. So if you see a patient in your office, and the child is admitted to and discharged from the hospital on the same day -- whether that patient is in observation status or admitted as an inpatient -- you must use one of the new codes: 99234, 99235, or 99236.
Other Observation Codes
What about 99217, 99218, 99219, and 99220?
99217 is a revised code for observation care [...]
