Wiki G0378- Observation- Status indicator N

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ShawnaB80

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Hello! I cannot get my head wrapped around this and am hoping to get some clarity. G0378 has a status indicator of "N"- meaning non covered and is usually bundled into another payment- such as an ED code. However, if I am seeing claims where the G0378 is being paid separately, does that have anything to do with the Hospital not utilizing the APC payment model? I've been researching this and am not yet finding a clear answer.
 
Hi,

I haven't seen observation charge bundled with ED/ER under hospital OPPS so far. And why the facility would require obs charge bundled with ER and/or for seperate payment when payers allow it to be billed under separate line item if documentation supports the service. This is strange. Observation is usually reported on a separate single line item with rev code 762 w/ single claim under hospital OPPS. You need to check with your facility/hospital department on charge description master file (CDM) and ensure if they are updated correctly per facility type/fee schedule, and to avoid non-compliance.

Thanks,
Manny
(Medicare institutional billing RTP specialist & investigator, CMS A/B expert, FI proficient, CPC)
 
manny23 said:
Hi,

I haven't seen observation charge bundled with ED/ER under hospital OPPS so far. And why the facility would require obs charge bundled with ER and/or for seperate payment when payers allow it to be billed under separate line item if documentation supports the service. This is strange. Observation is usually reported on a separate single line item with rev code 762 w/ single claim under hospital OPPS. You need to check with your facility/hospital department on charge description master file (CDM) and ensure if they are updated correctly per facility type/fee schedule, and to avoid non-compliance.

Thanks,
Manny
(Medicare institutional billing RTP specialist & investigator, CMS A/B expert, FI proficient, CPC)
Click to expand...

Hospital observation services are paid under comprehensive APC 8011. The G0378 is given a status indicator N, which signifies that the payment is always packaged to the comprehensive APC.

The Medicare Claims Processing Manual (Section 290.5.3 - Billing and Payment for Observation Services) gives more details on this. That section starts on page 275 at this link:

Novitas has a pretty user-friendly explanation of it here as well:


You can also read details in the Federal Register from 11/27/2024. Page 15 of this link: https://www.govinfo.gov/content/pkg/FR-2024-11-27/pdf/2024-25521.pdf
 
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