Physicians Practice - February 2008 - (Page 73)

CODING YOUR TOP CODING CONCERNS SOLVED GETTING OBSERVATION CODING RIGHT; CODING FOR PROLONGED VISITS B Y B I L L D A C E Y, C P C For physicians who infrequently admit patients for observation, it’s worth going over the rules associated with these services. There are code combinations that, although technically permissible, are not completely in compliance. A well-known rule associated with both observation and hospital inpatient admission is that all related E&M services billed on the day of the admission are included in the admit code if the same provider performs them. That applies to inpatient observation services as well. For example, if a and the hospital admit? After all, they are on different days. Well, you can, but you need to have separate notes that include the documentation requirements for both codes, namely, a comprehensive history and exam and decisionmaking of a certain complexity. It is unlikely that anyone would repeat much of that work within a 12-hour period, and the second visit would be better billed as a hospital followup day. How can you decide whether a patient is in observation or admitted? Here are some common indications of observation status: TIME IS MONEY Time is a precious commodity in a busy physician’s practice. Some other rules to live by: • Only the physician who admitted the patient to hospital observation and was responsible for the patient during that time may bill the hospital for observation care services. • When a physician bills for initial observation care codes, there must be a medical observation record for the patient that contains the physician’s dated and timed admitting orders regarding the care the patient is to receive while in observation. The record must include nursing notes and progress notes prepared by the physician while the patient was in observation status. • Other physicians who see the patient during observation must bill the ofﬁce using outpatient service codes or outpatient consultation codes as appropriate for their services to the patient. CODING FOR PROLONGED VISITS patient visits your ofﬁce complaining of chest pain and you send him for observation, test him further, and then admit him, you can factor services rendered in your ofﬁce and in observation into the admit code you choose. This rule stands even if someone else in your practice with the same specialty and group or tax ID number provided the ofﬁce services. But what if you admit a patient for observation at, say, 10 p.m., and the next morning admit him as an inpatient following test results? Can you bill both the observation admit WWW.PHYSICIANSPRACTICE.COM • The patient has spent signiﬁcant time in the facility undergoing tests or awaiting test results. She is still considered to be an outpatient. • The patient may be physically located in or assigned to an emergency department bed or another designated holding area. • Additional time is being used to observe the patient (and/or the patient requires further information and clariﬁcation of her clinical condition) to determine whether she can be treated in an outpatient setting or will require hospitalization. Time is a precious commodity in a busy physician’s practice. When a patient encounter goes well beyond the “usual” time associated with a given E&M code, you do have recourse to codes that will authorize payment for that extra time. Codes 99354-99357 should be used when a physician’s care involves direct (face-to-face) patient contact beyond the usual service in either the inpatient or outpatient setting. These are add-on codes, meaning they can be cited only in addition to the basic service — not reported alone. No modiﬁers are required. If you perform procedures during this period, you may also report them separately. Code 99354 or 99356 is used to note the ﬁrst hour of outpatient or FEBRUARY 2008 | PHYSICIANS PRACTICE | 73 http://WWW.PHYSICIANSPRACTICE.COM

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Physicians Practice - February 2008 Contents The Bigger Picture: Your Future is in Your Hands Letters Physicians Practice Pearls: Creating an A+ Practice Noteworthy Cover Story: Conquering Time: 5 Keys to a More Efficient Practice In Balance: A Family Affair Technology: Making EMRs Work in the Exam Room In Practice: "I've Got Some Bad News" The Tech Doctor - The EMR: Savior or Poseur? Ask the Experts NEW! Healthonomics: How to Handle Health Savings Accounts The Administrator's Desk: Finishing School for New Managers Human Resources: Is Your Partner Impaired The Great Practice Makeover: Too Well-Liked for His Own Good? Coding Idealab: 'Why I Blog' Classifieds Advertiser Index

Physicians Practice - February 2008

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