Wiki Observation timing

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tlwhlw

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I just want to clarify Observation coding....We had a patient go to ER in the evening, approx 7 pm. Our physician saw the pt the next morning at approx
8 am, then discharged her at approx 1 pm the same day. I have verified with the hospital that her status was Observation, as she did not meet criteria for inpt status.

So, I would code for our physician seeing this pt face-to-face as 99234-236 as appropriate per dictation. He actually dictated an H&P and DC summary. I'm hoping this is the correct codes to use, as the physician saw here within the same 24 hour time, using his face-to-face time, not when she entered the hospital the night before. ???

Thank you!!!
 
I believe you need to use the "admit" time, not the time he saw her. You'll have to confirm when the pt was placed in Obs status from the ER.
And it's not within a 24 hour time period, but on the same date of service.
 
If the doctor did not see the patient - face-to-face until the second day then he cannot bill the 99218-99220 and 99217. You would have to use the 99234-99236 codes since his services were provided all on the same date of service. One question I have is who wrote the order to admit the patient if he did not see the patient the night before? If your doctor isn't the admitting doctor then he wouldn't use the Observation codes anyway - he would have to use an Outpatient visit code.

Thanks, :)
 
After reviewing hospital records, the ER physician signed orders for her on 7/1/11 7:20pm to be assessed by Care Mgt, to determine her level of care. The ER physician dictated Disposition: Admitted in stable condition."

My physician first saw her 7/2/11 7:30am, noting observation status at that time.

I am more confused now....is it still appropriate to use the 99234-236 codes?
Thank you!
 
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