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    EM Coding Skill Sharpener

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    Supercoder
    This document outlines 3 rules for correctly coding hospital observation services: Rule 1 states that for stays spanning multiple days, report 99218-99220 for the initial date and 99212-99215 for subsequent days, plus 99217 for discharge. Rule 2 says to report only 99218-99220 without 99217 for stays under 8 hours spanning dates. Rule 3 is to report 99234-99236 for single-date stays, as these codes include admission and discharge.

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    EM Coding Skill Sharpener

    Uploaded by

    Supercoder
    142 views14 pages
    This document outlines 3 rules for correctly coding hospital observation services: Rule 1 states that for stays spanning multiple days, report 99218-99220 for the initial date and 99212-99215 for subsequent days, plus 99217 for discharge. Rule 2 says to report only 99218-99220 without 99217 for stays under 8 hours spanning dates. Rule 3 is to report 99234-99236 for single-date stays, as these codes include admission and discharge.

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    EM Coding Skill Sharpener

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    This document outlines 3 rules for correctly coding hospital observation services: Rule 1 states that for stays spanning multiple days, report 99218-99220 for the initial date and 99212-99215 for subsequent days, plus 99217 for discharge. Rule 2 says to report only 99218-99220 without 99217 for stays under 8 hours spanning dates. Rule 3 is to report 99234-99236 for single-date stays, as these codes include admission and discharge.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    142 views14 pages

    EM Coding Skill Sharpener

    Uploaded by

    Supercoder
    This document outlines 3 rules for correctly coding hospital observation services: Rule 1 states that for stays spanning multiple days, report 99218-99220 for the initial date and 99212-99215 for subsequent days, plus 99217 for discharge. Rule 2 says to report only 99218-99220 without 99217 for stays under 8 hours spanning dates. Rule 3 is to report 99234-99236 for single-date stays, as these codes include admission and discharge.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 14

    E/M Coding Skill Sharpener:

    Hospital Observation Services


    E/M Coding Skill Sharpener: Hospital Observation Services

    Follow 3 main rules


    for correct coding
    when reporting
    99217-99220 &
    99234-99236
    E/M Coding Skill Sharpener: Hospital Observation Services

    Rule 1 • Report 99218-99220 with 99217 if the


    physician 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 should report


    established patient codes (99212-99215)
    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.
    E/M Coding Skill Sharpener: Hospital Observation Services

    Examples
    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.
    E/M Coding Skill Sharpener: Hospital Observation Services

    Scenario 2
    The physician admits the patient to
    observation at 9 p.m. on Wednesday
    and releases the patient at 6 a.m. on
    Friday.

    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.
    E/M Coding Skill Sharpener: Hospital Observation Services

    You cannot report 99212-99215 as a


    separate service on the same date as
    99217-99220
    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 the ED
    E&M codes (99281-99285) rather than 99218-99220
    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/M codes
    99234-99236.

    Do not report a separate discharge code with


    99234-99236 because these codes include both
    the admission and discharge in their definition.
    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.
    E/M Coding Skill Sharpener: Hospital Observation Services

    www.supercoder.com

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