#OBSERVATION CPT CODES CODE#

She specializes in physician auditing, education, curriculum development, and consulting services. Irvine, CPC, CPMA, CEMC, CFPC, CPC-I, CCS-P, CMRS, has over 30 years of experience in the medical profession.

If the medical record documentation or the patient condition appears to fail to meet standardized admission criteria you could be a target for a RAC audit and could risk repayments to Medicare. I highly recommend auditing observation visits on a regular basis to prevent revenue consequences.

#OBSERVATION CPT CODES CODE#

No discharge code of 99238-99239 can be used. If the observation lasts for less than 8 hours on the same calendar day – 99218 – 99220, you cannot charge discharge code 99217.įor observations lasting a minimum of 8 hours but less than 24 hours on same calendar day –99234 – 99236, you cannot charge discharge code 99217.Īdmitted to Inpatient – less than 8 hours, use codes – 99221-99223. There are some eight-hour rules that also factor into these observation codes. Discharge code of 99217 is not used with 99234 – 99236. The same rules apply if a patient is admitted to the hospital, only hospital admit codes of 99221- 99223 would be used. Observation Care Services of 99234 – 99236 are utilized for services provided to patients admitted and discharged on the same date of service. This code of 99217 cannot be used with observation codes 99234 – 99236. You cannot use initial observation care codes 99218 – 99220 or subsequent observation care codes of 99224 – 99226 with discharge code 99217 on the same calendar day. Subsequent observation care codes are 99224 – 99226.ĩ9217 is used for discharge from Hospital Observation Services and cannot be charged if the patient is admitted to inpatient status. Keep in mind as well that any services provided in the office, emergency department, etc., are included in observation and cannot be charged separately. If the patient is admitted to the hospital on the subsequent day of observation admission, observation codes 99218 – 99220 would be used for the first day and initial hospital admit codes 99221 – 99223 used on the second day.Īlso, observation codes cannot be used for post-op if services provided are part of the global surgical package. If the patient is admitted to the hospital on the same date as observation admission, observation codes 99218 – 99220 would not be billed and hospital admit codes of 99221 – 99223 would be used. The terms '24-hour' or 'short-stay' have not been used in many years. There are some eight-hour rules that are used and will be discussed later in this article.

These codes are used for patients in observation over a calendar day. The facility does not need a designated observation area and patients are admitted to observation because their condition does not meet the status for admission. There is chaos in proper documentation, correct codes, and making sure everyone is on the same page for billing to avoid revenue consequences for hospitals and physicians.ĩ9218 – 99220: Hospital Observation Services, where the patient is considered an outpatient. I have personally experienced these disagreements and denials with payers and providers. CMS and many insurance payers are analyzing medical necessity of a one-day length of stay for inpatient admissions to hospitals versus observation.

Observation cpt codes