Criteria for Observation Codes' Use for Physician Services

Don't use discharge code 99217 in all observation situations

Oftentimes deciding on what observation code to use can be a challenge more particularly since you have to look into two sets of this type. One set (99234-99236) pertains to the care provided on a single calendar date whereas another set concerns care that spans two calendar dates (99218-99220).

Figure out the criteria for observation codes' use for doctor services by debunking these three errors.

Fallacy 1: Observation services aid extended inpatient care

First and foremost, you'd want to ensure that the service carried out by your gastroenterology qualifies as an observation. The doctor should choose for observation to prevent a lengthy inpatient admission. For example, an observation status is proper when:

The encounter certainly lacks diagnostic, where a more precise diagnosis could decide admission or discharge.

The patient's condition requires extensive therapy in order to possibly be abated.

For instance: The gastroenterology tends to a patient at the hospital who experiences abdominal pain and nausea with vomiting. The doctor admits the patient to observation status to run tests and make sure the patient does not need inpatient care for gastric issues.

Fallacy 2: Documentation just another paperwork

The doctor's notes on the encounter would tell you how many calendar days the observation service lasted.

Take into consideration this scenario: For example, the gastroenterologist admits the patient to observation at 9 p.m. on Wednesday. The doctor orders blood tests to check the patient's enzyme levels and performs a hydrogen breath test to check for any traces of bacterial overgrowth. The results of both tests turn out to be normal. The doctor keeps the patient overnight for monitoring; her notes indicate a level two observation.

Report it: You'd report the Wednesday services with 99219. To add to it, one more important component of coding multi-calendar date observation codes is reporting 99217 on the date of discharge service. Link 789.00 and 787.01 to both CPTs to describe the patient's symptoms.

Go for 99218-99220 for all the care rendered by the admitting physician on the date the patient was admitted to observation.

For the documentation requirements, the CMS Claims Processing (Source "http://www.supercoder.com/scrubber/cms1500/") Manual indicates that a doctor can bill the initial observation care codes, provided he finishes a medical observation record for the patient. This record should contain dated and timed admitting orders of the doctor, and mirror the care the patient gets while in observation, nursing notes, and progress notes made by the physician while the patient was in observation status.

This record should be in addition to any record prepared as a result of an emergency department or outpatient clinic encounter.

Fallacy 3: Same-day observation codes require a discharge code

What happens when your gastroenterologist admits a patient to observation status and discharges him on the same calendar date? Then you would go for 99234-99236. In this situation, you would not have to code the 99217 discharge code. CPT allows the use of 99217 “if the discharge is on other than the initial date of ‘observation status'," as specified on the code's descriptor.

Same-day observation services 99234-99236 involve documenting the time of the visit in hours (with a minimum of eight hours documented on the same calendar date, also referred to as the 8-hour rule).