Wiki Question 2023 Inpatient/ Observation coding

[surfergirl]

I have a question, when a patient is in OBV status we report appropriate I/P EM code however do I change the POS to reflect OBV status or does it remain as I/P?

Also Is the 3 year rule now in effect? Meaning that if my physician has seen a patient in the hospital within 3 years I can NO LONGER code Initial Visit it has to be a Subsequent visit I/P E/M?

Thank you

 

[rahammerl]

I was wondering the same thing, Surfergirl.

 

[jkyles]

I have a question, when a patient is in OBV status we report appropriate I/P EM code however do I change the POS to reflect OBV status or does it remain as I/P?

Also Is the 3 year rule now in effect? Meaning that if my physician has seen a patient in the hospital within 3 years I can NO LONGER code Initial Visit it has to be a Subsequent visit I/P E/M?

Thank you

Hi there,
1. You'll still use the appropriate place of service. Remember that the former hospital inpatient codes are now inpatient and observation codes.
2. No, the new/established patient concept and rules do not apply to facility visits. The initial/subsequent concept applies to a hospital stay. This is detailed in the new guidelines in your 2023 CPT manual.

 

[laurap]

What if a patient is in Observation, but then switched to in-patient a couple days later? What POS would you use for that day?

Thank you!

 

[AmandaBriggs]

You would use the POS for whatever the patient's status is at the time of the encounter. If the patient has been admitted as an inpatient, you would use POS 21.

 

[Drios22]

When the patient gives birth and goes in for an appointment for the new born, would the OV charge from the physician be new patient or established patient for the new born?

 

[wdorian]

We have submitted claims for patients in observation status; with inpatient coding (99222 and 99231) with POS of 22. UHC "Smart Edit" is rejecting the claims for inappropriate POS. I spent 2 hours on the phone with UHC and got no where. Am I understanding the new rules correctly?

 

[Cynthia Hughes]

When the patient gives birth and goes in for an appointment for the new born, would the OV charge from the physician be new patient or established patient for the new born?

If any physician or other qualified health care professional in the same specialty and same group has provided face-to-face care at the hospital, the patient is established when seen in the office. It is not the site of service that matter but whether any professional service has been provided prior to the current visit.
Hope this is helpful,
Cindy