Wiki Observation Billing

[Ami Denney]

I am in a debate and need some clarification from my fellow coding friends...

A patient is is admitted into obs status and is there less than 8 hours. I choose 99218 as the observation status charge. However, we have another point of view that beleives 99201 should be billed because it was less than 8 hours. It is my understanding that 99201-99205 and 99211-99215 are billed in physician office and outpatient settings such as immediate care facilities and other free standing outpatient facilities. NOT in a hospital observation setting...correct?

 

[kvangoor]

I agree with you, as long as the hospital has the patient designated as "observation status" and the documentation supports a 99218, then that is what would be appropriate. If there is not enough to support a 99218 ( for example, there was not a detailed exam) then a 9920X should be used.

 

[karey]

It ultimately depends on what the hospital classifies the patient as. Observation or Outpatient. If the hospital has the patient classifed as an outpatient then you would use the Est/New E/M codes (used to report services provided in the office or in an outpatient or ambulatory facility). If they have them classified as observation then you would use the Observation codes. Most hospitals have a separate area for outpatient visits. You will have to contact the Hospital to see what they consider outpatient as you can be classifed as an outpatient for several days.

A patient is considered outpatient until inpatient admission to a health care facilty occurs.

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You're an outpatient if you're getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays, and the doctor hasn't written an order to admit you to the hospital as an inpatient. In these cases, you're an outpatient even if you spend the night at the hospital.

 

[Emmy1260]

Was the patient is admitted as observation status and discharged the same day? If so, a code from 99234-99236 should be used. (8 hours could fall in 2 calendar days)

First thing you need to know is what the admission order states - inpatient, observation, or outpatient.