Pulmonology Coding Alert

Here's a handy tool to help you keep charge and discharge details straight 

To comply with Medicare's "Eight-Hour Rule," keep an eye on how long the patient spends in observation status on what dates.

Financially, CMS' short observation stay coding rule may make sense. Medicare "views a same-day observation discharge more than eight hours after the admission as equivalent in work" to an admission and discharge on different dates," says Brett Baker, a third-party payment specialist with the American College of Physicians.

Payment: You'll receive about the same Medicare reimbursement for an extended same-day observation admission and discharge as one that occurs on subsequent days. Codes 99234-99236 contain 3.58-5.89 relative value units and reimburse at an unadjusted Medicare rate of $135.67-$223.22.

Medicare pays about the same total amount ($138.33-$228.52) for a two-day observation stay using 99218-99220 (1.78-4.16) and 99217 (1.87 RVUs). CMS Transmittal B-00-65 clarifies that you should assign observation care codes (99217, 99218-99220, 99234-99236) based on the following time and date criteria: