EM Coding Skill Sharpener

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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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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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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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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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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You cannot report 99212-99215

as a separate service on thesame date as 99217-99220


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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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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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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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www.supercoder.com


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Documents

EM Coding Skill Sharpener