While reporting the middle day observations, this year you have new options to choose from. If you want to find out how CPT additions will have a say on your orthopedist's observation care services, read on and find out:
New codes bring clarity with them. Before the start of this year, coding for the 'middle days' of an observation service was a pain in the neck. Even though, it's not the norm, there are situation where a patient is admitted to observation and remains in that status for three or more days. The E/M section of CPT 2011 addresses these middle days with new codes. The three codes that parallel the hospital subsequent care series in terms of component requirements and time frames are 99224, 99225 and 99226.
There has been some confusion on ways to report the middle day for those cases when an observation period transcends three calendar days. The new CPT codes
99224-99226 stamp out insurer variances. There has been some uncertainty about how to report the middle day for those cases when an observation period transcends three calendar days. The new codes however solve the problem.
Prior guidance for these 'extended' observation and middle day observation stays created some confusion and led to different policies such as the Spring 1993 edition of CPT Assistant, which instructed coders to “use the unlisted evaluation and management service code to report these services."
However, when setting policy on 'middle day' observation coding, payers often took their own path. They would often call for 99499; but then some carriers preferred 99231-99233 or 99211-99215. Technically speaking, observation codes are outpatient codes.
But be ready for disappointing reimbursement. Physicians and coders who were excited about the new subsequent care observation codes will not be too happy when they hear the accepted payments for these codes. The Relative Value Update Committee had compared this year's codes 99224-99226 for subsequent observation care to subsequent hospital care and had requested the same work value. However, the Center for Medicare disagreed with the proposal.
You should focus this time clarification in your CPT 2011 manual. All that fine green print on time in your evaluation & management CPT 2011 manual comes down to one thing: you can round to the closest time code. However that advice from CPT is quite opposed to Medicare's threshold time guideline. This year's CPT tells you that you can use the code closest to the documented time. This advice is nothing new. In choosing time, the doctor must have spent a time closest to the chosen code, according to CPT Assistant, Aug 2004.
For further CPT details and for other information relating to CPT Assistant, sign up for a one-stop medical coding guide like Supercoder. This site comes with a CPT Assistant Code Connect for just $199.95 to help your understanding. In fact, the site offers 20 years of CPT Assistant articles and reader questions linked to every applicable CPT code. Source URL :- http://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/cpt-2011-99224-99225-99226-solve-middle-day-code-dilemma-103938-article
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