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EM Coding Skill Sharpener

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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220 views14 pages

EM Coding Skill Sharpener

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.

Uploaded by

Supercoder
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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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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