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Observation Subsequent Care

Lynne Posted Wed 24th of October, 2012 17:57:20 PM

We were provided a charge for OBC subsequent (99225) without the intial Observation Care Code. The coder said that there was not enough documentation to code the vist as intial only subsequent. The patient was only seen the one time by the physcian in observation.
Is the coder correct to only charge the subsequent and not an initial? Was the response we received a valid reason for not coding it as initial?

SuperCoder Answered Thu 25th of October, 2012 14:29:59 PM

The subsequent observation care codes (99224-99226) allow the reporting of extended observation care services because there are circumstances when a patient is initially admitted to “observation status” in the hospital, with the need to extend observation care services beyond the initial day of service.

For subsequent observation care services performed on a date other than the initial observation care services (99218-99220), codes 99224-99226 or observation care discharge service (99217) should be reported. To illustrate, if the physician initiates observation status on Monday, continues to observe the patient on Tuesday, and discharges the patient from observation status on Wednesday, the E/M services provided on Tuesday are reported with the appropriate level subsequent observation care code (99224-99226). Code 99217 would be reported for the discharge services performed on Wednesday if a face-to-face encounter occurred on that date, and therefore, on the date of discharge.
Prolonged service in the inpatient or observation setting (99356, 99357) may now also be reported in addition to observation services (99218-99226), when performed by a physician or other qualified health care professional.

There has to be an initial observation code in order to correctly bill 99225.

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