Wiki scheduled procedure and observation codes

[Dialmam]

Hi - I audit professional services. I have a case where a neurologist saw the pt and scheduled a video EEG for a month later. On the day of the EEG, a hospitalist is billing obs admit code and discharge code the next day. This does not seem right as there were no other complications warranting another evaluation prior to the procedure. This is a medicaid case. I know Medicare has rules about billing observation for certain procedures but not sure those apply. Any thoughts or suggested references? thanks

 

[Kris Cummings]

The video EEG required an overnight observation in the hospital, I presume?

If so, a patient can't just have the procedure, they do have to be admitted to observation. I recommend verifying the rules with your state Medicaid site/provider inquiry, but for procedures that require an overnight to complete the testing without needing a full inpatient status are reimbursable.

Let us know what you find out.