Francisco Posted Fri 05th of October, 2012 17:13:37 PM
Patient returns to the office for post-op visit/pack removal after septo/SMR. Patient had profuse bleeding in office and had to be repacked. It was decided to admit patient to hospital for observation on the same day. Can I charge for packing the nose, and also for admission for observation? What is the proper coding?
SuperCoder Answered Fri 05th of October, 2012 19:51:27 PM
Observation services after surgery may be warranted when the physician documents a medically necessary reason or reasons for the observation service. The Medicare Benefit Policy Manual (Pub 100-02), chapter 6, section 20.6b, states: “The purpose of observation is to determine the need for further treatment or for inpatient admission.”
Additionally, the Medicare Claims Processing Manual (Pub 100-04), Chapter 4, Section 290.2.2 states:
General standing orders for observation services following all outpatient surgery are not recognized. Hospitals should not report as observation care, services that are part of another Part B service, such as postoperative monitoring during a standard recovery period (e.g., 4-6 hours), which should be billed as recovery room services.
In order to meet both requirements, the documentation must reflect extenuating circumstances that support medical necessity for post-operative observation services. Examples include severe nausea or vomiting, uncontrollable pain, unstable blood pressure, or other complications. The documentation must also reflect physician evaluation to support observation services in accordance with Medicare Claims Processing Manual (Pub 100-04), Chapter 4, Sect 290 which states:
a. The beneficiary must be in the care of a physician during the period of observation, as documented in the medical record by outpatient registration, discharge, and other appropriate progress notes that are timed, written, and signed by the physician.
b. The medical record must include documentation that the physician explicitly assessed patient risk to determine that the beneficiary would benefit from observation care.
In this case you can report it with G0378.
Medicare does not cover routine or standard post-operative observation, and as a result you should have the patients sign an advanced beneficiary notice (ABN). Information concerning ABNs related to observation services is located in the Medicare Benefit Policy Manual (Pub 100-02), Chapter 6, Section 20.6c
Francisco Posted Mon 08th of October, 2012 15:57:00 PM
Outpatient surgery "30520", '30140' on 9-26-12. Patient was back for office visit on 9-28-12 for pack removal. Upon pack removal, the patient started bleeding profusely, and had to be re-packed '30903-50' in the office. Can I charge for the packing, using a modifier '79'? At this time, we admitted this patient to the hospital for observation '99218-79' in regards to the bleeding. Can I charge for both the packing, and the observation, since they occur on the same day?
SuperCoder Answered Mon 08th of October, 2012 21:11:45 PM
Since here the patient was in observation after packing had been done in office resulting from profuse bleeding. It does not raise extenuating circumstances that support medical necessity for post-operative observation services. Rather it is for routine observation after the procedure done. Use 30903 with 79 only and not observation code.