Hospital observation

The doctor saw patient in the hospital - the patient was there for 2 days. The hospital states it was an observation and I should code it as an outpatient visit; however, I'm not familiar with this. Do I code like an office visit? What do I put as the POS? This is probably elementary to many of you, but it's a confusing to me. He saw her twice in the hospital, they said she didn't qualify for admission but they couldn't let her go, so it's observation. As always, thanks for your learned reply.

Observation

Not knowing the "hospital" details, I will comment only on observation status. If the physician is the admitting physician to Observation, the code is based on documentation to support 99218-99220, only for admission day. If the patient was discharged home the next day, the code for discharge from OBS is 99217. If the patient was admitted and still there on day 2 = established OV code, if the patient was discharged home on day 3 = 99217. The place of service is outhospital.

Not admitting

He was not the admitting physician. He was called in as a consultant. I'm not sure what "outhospital" means - is there a POS code for that? So the physician saw her on day 1 and day 2 to check on her. Someone else admitted and discharged her. Thanks for your response.

observation

If this is a Medicare patient, the code choice after January 1, 2010 is 99201-99205. The diagnosis should reflect the reason for consult. POS for outhospital is 22. Day 1 is a new patient (not seen in 3 years or new to physician). The code range for day 2 is 99212-99215, as documented.

You are not alone

I am waiting for the uproar when the Medicare Contractors start to compare the hospital billing to physician billing and start rejecting physician billing for wrong place of service or visit type. I would bet most doctor offices do not code consultations on Observation patients correctly, and certainly not since the new elimination of consult codes.

Thank you

Thank you for this answer. It makes sense to me. Unfortunately when our physician gets called to see a patient, he has no idea if they're observation or inpatient. So, when I get it to bill, I have to check everything out. You and signaturedoc have been a great source of information to me.

Signaturedoc, read your letter in the Physician Practice magazine -I'm impressed.

Hospital Observation

Hospitals will usually use InterQual or Milliman criteria to determine the necessity of inpatient status. However, the attending physician should be notified of any status change if an inpatient order has been written. Sounds like this patient did not meet the criteria for inpatient. If your physician acted in a consultation role, not the attending role, they would not have received notice of any proposed status change. Correct pos for hospital outpatient/obv is 22.