Forum - Questions & Answers

May 6th, 2011 - brajt

Written Orders for Observation

I understand that Observation Patients need a written, timed and dated Observation order at the same time of the Observation Status. I have reviewed CMS guidelines regarding issue and understand them. However, I need addiitional clarification in regards to the written orders. The floor that is "Observing" the patient is a Telemetry Unit along with CHF. The issue is coming up when a moonlight from the Cardiology Department (fellow) will do the admission for OBSERVATION and write/time/date the order. He will do a full note, basically minimual requirements needed until the staff dr comes in for his shift (lets say for arguement fact it is at 430 am). The staff dr (hospitalist) then will come on for his shift 6am and will review the chart and do a complete work up H&P, completely meets the criteria for an Observation code 99218-99220. However, what is happening is that Dr that wrote the Written Order (Fellow) is not being billed for and the Staff Dr (Hospitalist) is now being billed out as a Office Visit - New Patient (99213-99215 codes).
The real question is since the fellow is being employeed by the Hospitalist division, writing the orders for Observation, and the Staff Dr is essentially writing the H&P can we bill the Obs codes for the patient or does it have to be the Office Visits.
Is there any documentation to validate that the Specialty that is admitting the patient is the only one that can bill the Observation or not?

May 7th, 2011 -

re: Written Orders for Observation

My make my head spin!

It sounds like the moonlighter is not billing for their service and the hospitalist in the am is doing a complete assessment and plan. The hospitalist is entitled to bill the initial observation code 99218-99220. I see no reason the office visit codes would be used at all; there are now codes for subsequent observation visit that are used by the attending physician; only consultants have to use office visit codes for subsequent observation visits.

May 9th, 2011 -

re: Written Orders for Observation

That is exactly what is happening, they are not billing for the Moonlighter and using the Hospitalist note. The issue is coming up with the Written order. I am seeing the written order from the Moonlighter and then the H&P being billed as an office visit because the coders/billers are stating the written order needs to be done by the person doing the H&P.

May 9th, 2011 -

re: Written Orders for Observation

Who ever said that the person who gives the admit/observation order is the only one that can bill for the visit? What if the ED called the on-call doc at 5 am who gave a telephone order for admission and at 8 am the patient's primary doc rounded and did the H&P. They would not bill that H&P? Just plain silly!



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