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Pulmonology Coding Alert

READER QUESTIONS:

Is Inpatient Code OK for Observation Patient?

Published on Fri Oct 23, 2009

Question: I've been told to use a standard outpatient consult code (99241-99245) for a patient admitted for observation and use place of service 22 (outpatient). But I've also heard that for a visit the following day, when the patient is still in observation, I should use a daily hospital visit code (99231-99233) with POS 21 (inpatient). Is this correct? Florida Subscriber Answer: You are correct in using the outpatient codes and place of service (POS) on the first day. Also you should do the same on the second day, reporting the appropriate outpatient visit code based on the doctor's documentation. The Medicare Claims Processing Manual (www.cms.hhs.gov/manuals/downloads/clm104c12.pdf) explains that inpatient codes are not correct for patients in observation. Consider the following excerpts: • "Payment for an initial observation care code (99218-99220) is for all the care rendered by the admitting physician on the date the patient was admitted to observation. [...]
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