Wiki inpatient and observation codes

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Ruth824

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When billing for professional E&M services the physician submits a charge for an inpatient stay. The hospital information states the patient was in observation on the first and second day and then converts the patient to in-patient on the third day. Is it correct to keep the professional billing as in-patient for all days or does the professional and hospital billing need to match?
 
Physician coding/billing must match the patient status reported by the hospital.

If they have the patient as
day 1 outpt/OBSV
day 2 outpt/OBSV
day 3 inpatient
then your E&M codes must reflect these same POS.

The reimbursement for inpatient care vs outpatient care is different for the facility and for your E&M codes. If you report differently from what the hospital has reported, your E&M services will be denied
 
Remeber to only use the Obs codes if your physician was the one admitting pt to observation, otherwise use outpatient codes
 
Here is a paste of the guidelines for coding OBSV

Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient's observation services began.

All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes.

Example: If an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial observation care code. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate.
 
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