Advanced Search

Pulmonology Coding Alert

Reader Questions:

Choose POS With Caution Under "Observation Status"

Published on Mon Apr 18, 2011

Question:

As follow-up to the previous question, our office also gets a lot of denials for E/M observation services because of incorrect POS coding. What is the appropriate POS code to use for patients placed on "observation status"?

New York Subscriber

Answer:

The answer can be tricky. First, you have to examine the definition of "observation status." A patient may end up spending 12 hours or more in the ER just waiting to receive full treatment, but that doesn't mean he is being observed. The documentation should confirm that a physician did in fact place the patient in observation.

When reporting an observation service, you would use a code in the 99217-99220, 99234-99236 or 99224-99226 set. The place of service codes work out like this:

22 (Outpatient hospital) is appropriate when a patient comes in through the ER, the physician places the patient on observation status. For instance, a patient complains of chest tightness and shortness of breath. The patient comes to the ER and the physician decides to keep her at the hospital under observation status to have pulmonary test make sure everything's OK. The patient then is admitted under "observation status" with a POS code of 22. The observation "bed" can be located anywhere in the facility. It may not be a separate unit designated as observation only.

23 (Emergency room " hospital) is appropriate when the patient comes in through the ER, the physician keeps the patient in the ER for observation without formally changing him to "observation status," and the physician keeps the patient assigned as an ER patient for the duration of the observation until released.

21 (Inpatient hospital) is reported if the patient status changes and the patient is admitted to the hospital as an inpatient. 

Other Articles in this issue of

Pulmonology Coding Alert

View All