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According to the Medicare Hospital Manual how is the "observation" of patients described?
Services at a hospital ordered by Dr or ... incl. a bed & periodic monitoring by staff, to evaluate pt's condition to determine admission
What classify s an Observation status?
A patient who does not have an illness severe enough to meet acute inpatient needs.
What is being monitored during the observation period?
The severity of the condition, if the pt can be treated as an outpt basis or if they will need to be admitted.
What are the similarities b/t E/M codes and the Observation codes?
Codes are based on Level of Service;Location, pt. status, etc. But w/Observation there is no time component.
How is the observation code billed if the pt. is admitted on the same day?
The Observation code gets bundled into the Inpatient Hospital Admission code.
What does the Observation Care Discharge Service entail?
Final examination of the pt, discussion of hospital stay, instructions for continued care & prep of D/C records
When is the only time an Observation Care Discharge Service code is used?
On a day that follows the 1st day of observation.
What are codes 99218 - 99220?
Codes that are used to designate the beginning of observation status = Initial Observation Care codes
Where are pt's located in the hospital who are in Observation status?
There is no specific area, some hospitals have a temporary care unit (TCU). Designation is really dependent on the severity of the illness.
What are the requirements of an Initial Observation Care code?
They include development of a care plan for the pt. & periodic reassessment while on Observation status.
How often can a Observation admission be reported?
Only on the 1st day of service.
What if the pt. is admitted & D/C on the same day during observation what code is used?
Observation or Inpatient Care Services codes 99234 - 99236
What if a pt stays overnight during observation and is there for less than 48hrs?
1st day-Initial Observation Care - 99218-99220 2nd day-Observation Care D/C Services - 99217
What if a pt stays longer than 48hrs in observation?
1st day-Initial Observation Care - 99218-99220 2nd day or Subsequent day/s-Est.Office or Other Outpt Services 99211-99215 D/C day-99217
What if a pt. is seen in a clinic/ER/nursing home and then the pt. is admitted to an Observation status, how is that billed?
This would have to be bundled into the Initial Observation Care codes and not coded separately.
Code if an Est.pt. has been seen in the Dr's office for frequent fainting of unknown origin and then sent to the hospital for Observation?
Code from the Hospital Inpatient Services subsection, Initial Observation Care subheading to report Observation Status - 99219 w/o billing the ov
What if the pt. becomes ill enough to be admitted to the hospital and taken out of observation status?
Code from the Initial Hospital Care code - 99292 - 99223
Place of service for Observation Status?
22 - Outpatient hospital
Who is able to bill for the Observation status?
Only the "Admitting" physician
What would another physician other than admitting code?
Code using Office or Other Outpatient Procedure Codes 99202 - 99215