Forum - Questions & Answers

Nov 9th, 2015 - Sha12 62 

Observation vs Inpatient

Pt was initially admitted to observation for a day. The next day, the pt was admitted as inpatient due to severe medical condition. Can I code the first day as Observation, then the next day, I can bill it as INPATIENT HOSP CODE? Please help.

Nov 10th, 2015 -

re: Observation vs Inpatient

It depends on the documentation. If the second day the physician documented a full H&P, you can bill an initial inpatient hospital visit. I'd go with low level. If the note is more like a followup, then use 99231-3

Nov 10th, 2015 - Mand0984 11 

re: Observation vs Inpatient

Yes

Nov 10th, 2015 - lmckenna 19 

re: Observation vs Inpatient

to signaturedoc - I've coded observation to inpatient for years. I've never seen the CPT® as you have it. 99231-3. What does the modifier 3 represent please?

to Sha12: if you are billing the professional component, you should code the observation DOS for as many days as the pt is in observation. When pt is admitted signaturedoc is correct in saying if a full H&P is done, the provider can get credit for an initial hospital visit, Otherwise bill the appropriate subsequent in patient code. If you are billing for the facility you bill the entire visit as either Observation or inpatient.

*cms online manual chapter 12 30.6.8 - read that whole section to learn how to bill observ etc.

Nov 10th, 2015 - rphelps 615  1 

re: Observation vs Inpatient

She is not saying modifier 3. She is tellng you to bill 99231, 99232 or 99233.



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