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8/8/2019 EM Coding Skill Sharpener
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8/8/2019 EM Coding Skill Sharpener
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E/M Coding SkillSharpener: Hospital
Observation Services
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E/M Coding Skill Sharpener: Hospital Observation Services
Follow 3 main
rules for correct
coding when
reporting 99217-
99220 & 99234-99236
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E/M Coding Skill Sharpener: Hospital Observation Services
Rule 1 Report 99218-99220 with 99217 if thephysician admits the patient to
observation and releases her on a
different date of service. For stays lasting multiple days, you may
report one unit of 99218-99220 for the
first date of service
For subsequent days you shouldreport established patient codes
(99212-99215)
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E/M Coding Skill Sharpener: Hospital Observation Services
What Medicare says..When a patient is held in
observation for more than two
calendar dates, the physician
must bill subsequent services
furnished before the date of
discharge using the
outpatient/office visit codes, but
should not use the subsequent
hospital care codes since the
patient is not an inpatient of the
hospital.
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E/M Coding Skill Sharpener: Hospital Observation Services
ExamplesExamples
Scenario 1
An emergency department (ED) physician admits a
patient to observation status at 9 p.m. on one day,
and discharges him early the next day at 6 a.m.
Report
Code 99218-99220 (initial observation care level)
for the first calendar date and discharge code(99217) for the second calendar date and include
complete documentation in discharge notes.
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E/M Coding Skill Sharpener: Hospital Observation Services
The physician admits the patient to
observation at 9 p.m. on
Wednesday and releases the
patient at 6 a.m. on Friday.
Scenario 2
Report
Code 99218-99220 for the first day and 99217 for the
discharge.
You may report 99212-99215 if the physician documents an
E/M service on Thursday.
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E/M Coding Skill Sharpener: Hospital Observation Services
You cannot report 99212-99215
as a separate service on thesame date as 99217-99220
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E/M Coding Skill Sharpener: Hospital Observation Services
Rule 2
For stays of fewer than eight hours
when the admission and discharge
occur on different dates of service,
report 99218-99220 only, without a
discharge service.
For Medicare patients receiving fewer than eight hours of
observation care in the ED, many providers will rely on theED E&M codes (99281-99285) rather than 99218-99220
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E/M Coding Skill Sharpener: Hospital Observation Services
Rule 3
For observation stays that take place within
a single DOS, you should report the
observation/inpatient hospital care E/Mcodes 99234-99236.
Do not report a separate discharge code
with 99234-99236 because these codesinclude both the admission and discharge in
their definition.
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E/M Coding Skill Sharpener: Hospital Observation Services
If the patient is discharged
on the same date as
admission to observation,
pay only the initial
observation care code
because that code
represents a full day of
care.
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E/M Coding Skill Sharpener: Hospital Observation Services
www.supercoder.com
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