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place of service for Observation status

Joshua Posted Fri 02nd of March, 2012 18:31:16 PM

Does anyone know the proper place of service code for Observation status? Is it inpatient or outpatient? Some are described as inpatient observation, for tose I figure to use the inpatient location, what about the codes that dont state inpatient, can they be set up as outpatient or does it matter?


SuperCoder Answered Fri 02nd of March, 2012 18:53:29 PM

This is a tricky question. First, you have to examine the definition of “observation status.” A patient may end up spending 12 hours or more in the ER just waiting to receive full treatment, but that doesn’t mean he is being observed.Check all the documentation to be sure a physician did in fact place the patient in observation.

Once you’ve determined that you should bill an observation code (99217-99220, 99234-99236), the place-of- service codes work out like this:

– 21 (Inpatient hospital) is appropriate when a patient comes in through the ER, the physician places the patient on observation status, and subsequently the physician decides to move the patient to a separate observation area or admit the patient to the hospital.

For example, if a patient has chest pains, comes to the ER, and the physician decides to keep the patient at the hospital under observation status to have an EKG and make sure everything’s OK, the patient is admitted under “observation status.” Therefore, you bill for an E/M observation service with the inpatient place-of-service code (21). The key is in the documentation: The patient must be documented as on “observation status.”

– 22 (Outpatient hospital) is never used for observation services.

– 23 (Emergency room — hospital) is appropriate when the patient comes in through the ER, the physician keeps the patient in the ER for observation without formerly admitting him on “observation status,” and the physician keeps the patient on-site in the ER for the duration of the observation and until released

Joshua Posted Mon 19th of March, 2012 19:37:12 PM

the response to my question is not correct.
thanks anyway... I will have to find a more info elsewhere.

SuperCoder Answered Mon 19th of March, 2012 21:29:32 PM

Let the physician’s documentation drive the appropriate place of service. If a patient was in observation, then use POS 22. But if the patient was actually admitted and discharged on the same day, then go with POS 21.

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