Observation in PCP Office

We had a patient in the office for 7 hours under observation due to a panic attack he was having, and he did not want to go to the hospital. The Dr. gave him a shot to calm him down, and he slept most of the time. What do we bill for this? Dr's face to face time with patient was approx. 2 1/2 hours, with nurses checking every 30 mins. Dr. also drove patient home.
How should I bill this?

Office

You bill the level of E/M service performed with physician face-to-face (History, Physical, MDM) and if that level was exceeded by 30 minutes time, bill prolonged service code as appropriate for monitoring the patient. No charge for driving home. You did not mention "counseling", if physician counseled patient for greater than 50% of face-to-face encounter, bill on total face-to-face "time" and then use prolonged service codes as appropriate.

Counsiling of course

Oh yes, her time was mainly spent counsiling, so this would defininatly meet the 99215. What I am curious is the 99354 and 99355 for prolonged visits indicate face to face time. I can bill up to 2 1/5 hours on this, but the pt was observed all day (7 hrs) ... can I still bill these for the time he was observed?

must be

face to face with the doctor- time she actually spent IN THE ROOM. If you bill this be prepared to back it up with time documentation, especially if you bill 2.5 hours. You may need to recreate "Pt in room 9:15 to 10:10am, 10:30 to 10:45 am" etc.

Time

You cannot bill nurse time for prolonged time,only face to face with physician. You must document each face to face and what was done or observed.

Observation, prolonged services, time

There are a couple of articles in the Codapedia database about prolonged services. They might be helpful to you.

search for observation in the search box.