E/m Coding: Learn The Importance Of The Eight-hour Rule

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Clue: Don't use discharge code 99217 in all observation situations.


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


Figure out the criteria for observation codes' use for physician services by looking closely into these three fallacies.


Fallacy 1: Observation services support extended inpatient care


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


The encounter lacks diagnostic certainty, where a more spot on diagnosis could decide admission or discharge.


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


Fallacy 2: Document, one more paperwork


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


Consider the previous scenario: Say for instance 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 (91065, Breath hydrogen test [e.g., for detection of lactase deficiency, fructose intolerance, bacterial overgrowth, or oro-cecal gastrointestinal transit]) in order to check for any traces of bacterial overgrowth. The consequences of both tests turn out normal. For monitoring, the doctor keeps the patient overnight. Her notes point to a level two observation.


You would report the Wednesday services with 99219. 99219. What's more, another key component of coding multi-calendar date observation codes is reporting 99217 on the date of discharge service. Connect 789.00 and 787.01 to both CPTs to describe the patient's symptoms.


Report 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 Manual points out that a doctor can bill the initial observation care codes, provided he completes a medical observation record for the patient. This record should have dated and timed admitting orders of the physician, and reflect the care the patient gets while in observation, nursing notes, and progress notes arranged by the physician while the patient was in observation status.


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


How about your gastroenterologist admits a patient to observation status and discharges him on the same calendar date? Then you would code 99234-99236. In this case, 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 mentioned on the code's descriptor.


Same-day observation services 99234-99236 include 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 eight-hour rule).


For further details on this and for other specialty-specific articles to assist your gastroenterology coding, sign up for a good medical coding resource like Coding Institute.