Wiki Observation coding help

[TLC]

Hello,
I'm wondering if a patient is having "outpatient" surgery in the hospital eg: hysterectomy, and she is kept in observation for less than 24hrs can you bill also for observation? I did see that it would be considered as "outpatient" but I'm not sure if you can bill for it also? Is there any good sites with this information?

Thank you,
Terry

 

[bench]

Hi Terry, I just came across your post and read your inquiry. I am with an ASC and we do observation or what we call overnight stay. For our setting, and the patient stayed for observation, patient needs to be d/c before 24 hrs. We can bill for the service but only if our contract with the payer allow reimbursement for overnight. It should state in your contract if you can bill or maybe inclusive to your services. I hope this helps a little.

 

[amyjph]

https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00091093 https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00005000

https://medicare.fcso.com/EM/0448434.asp

"Do not order observation services for a future elective surgery or outpatient surgery cases. Neither pre-operative nor post-operative services meet the definition of observation care."

If you are talking about the provider/surgeon who ordered and performed an elective oupatient surgery, you can't bill for observation during the post op of the global case.
The facility is different.

Search "observation" here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf
and here: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf
Specifically: 30.6.8 - Payment for Hospital Observation Services and Observation or Inpatient Care Services (Including Admission and Discharge Services)

E. Hospital Observation Services During Global Surgical Period The global surgical fee includes payment for hospital observation care services unless the criteria for use of CPT modifiers “-24,” “-25,” or “-57” are met. A/B MACs (B) must pay forthese services in addition to the global surgical fee only if both of the following requirements are met:• The hospital observation service meets the criteria needed to justify billing it with CPT modifiers “-24,” “-25,” or “-57” (decision for major surgery); and • The hospital observation service furnished by the surgeon meets all of the criteria for the hospital observation code billed.