Coding, Classification & Reimbursement

Current billing guidelines for observation to inpatient admission for providers

  • 1.  Current billing guidelines for observation to inpatient admission for providers

    Posted 3 days ago
    If a patient is admitted under observation status and on day three is admitted as an inpatient, is this class change retroactive? Should the initial hospitalist E&M code be an observation or inpatient code? I have found multiple aapc posts where people state that the day the patient changes class the initial IP E&M code is billable if documentation supports but I don't think this is right.


  • 2.  RE: Current billing guidelines for observation to inpatient admission for providers

    Posted 3 days ago
    CPT: "For a patient admitted to the hospital on a date subsequent to the date of observation status, the hospital admission would be reported with the appropriate initial hospital care code (99221-99223). Does this mean the first day of arrival at hospital, as observation status, is retroactively changed to initial hospital care or does it mean that the day the patient was admitted (meaning inpatient)...say on a subsequent day of initial observation care, is reported as 99221-99223?

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    Heather Mayes
    Medical Coder
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  • 3.  RE: Current billing guidelines for observation to inpatient admission for providers

    Posted 3 days ago
    I've asked this question before and never got a response, please help!

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    Heather Mayes
    Medical Coder
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  • 4.  RE: Current billing guidelines for observation to inpatient admission for providers

    Posted 3 days ago
    For patients admitted to observation and then transferred to acute on the 3rd hospital day, I code the admission day as an observation admit E&M depending on the level of documentation.  For day 2 I use the observation subsequent E&M depending upon the documentation.  On day 3 when the patient is transferred to acute, I code inpatient E&M depending upon the documentation.  I don't use a second admit E&M mainly because the progress note on the 3rd day does not meet the documentation requirements for an admit E&M and charging another admit just doesn't seem correct in my opinion.  Would love to hear other opinions out there.

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    Nelda Laskey RHIT
    Coder/RAC Coordinator
    Kearny County Hospital
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  • 5.  RE: Current billing guidelines for observation to inpatient admission for providers

    Posted 2 days ago
    Nelda,

    Hi, so I have also been coding this way but many many coders have told me this is wrong and that once a patient changes to inpatient status, it is always retroactive and we must then change the initial observation care codes to inpatient ones. As of yet, I have not been able to get anyone to point me towards this policy. I feel like we need more input from others on this topic.

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    Heather Mayes
    Medical Coder
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