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BILLING OUTPATIENT OBSERVATION CODES

Donna Posted Mon 14th of July, 2014 15:20:13 PM

How would I code a hospital visit given to me by a physician as an
initial hospital visit level 3, if the hospital has the patient listed in observation care? I know the codes 99212-99215 are appropriate in some instances, but when would these be more appropriate than the ob codes 99218-99226 or 99234-99236?

SuperCoder Answered Tue 15th of July, 2014 03:57:42 AM

When the patient is in inpatient status and the provider renders the evaluation and management service, there are following range of codes that may be reported basis level of service performed in Initial hospital visit care per day.

99221-99223 (Initial hospital care per day visit, E/M codes)

99221 represents 'Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity.'

99222 represents 'Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity.'

99223 represents 'Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity.'

Observation care codes 99218-99226 or 99234-99236 are to be used when the patient is in observation status.

99212-99215 are the office visit code to be used when the patient is seen by the provider in his office.

Hope it will help. Thanks !!

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