Pediatric Coding Alert

Question: We kept a patient in the hospital overnight for observation and decided the next morning that surgery was not necessary. Should I report 9923x and discharge code 99217 even though within the hospital this stay remains outpatient?

North Dakota Subscriber

Answer: If a patient stays overnight (past midnight) in observation, you cannot report the codes for observation or inpatient hospital care 99234-99236. Instead, you must report the appropriate code for "hospital observation, initial observation care" from the range 99218-99220 on the day the patient was admitted; you would also report 99217 (Observation care discharge day management) on the day the patient is discharged, as you suspected.

Tip: You should only report 99234-99236 when a patient is admitted and discharged on the same day. As soon as you realize that the patient is not admitted and discharged on the same calendar day, you'll need to fight the urge to report those codes.