If the patient is still in observation status at the time of discharge, use
99217
. If the patient is an inpatient, use codes 99238 or 99239. Remember to use observation discharge when the patient’s status is observation and use inpatient discharge when the patient’s status is inpatient.
How do you bill for observation services?
For patients in observation more than 48 hours, the physician of record would bill an initial observation care code (
99218–99220
), a subsequent observation care code for the appropriate number of days (99224–99226) and the observation discharge code (99217), as long as the discharge occurs on a separate calendar day.
What is the CPT code for 23 hour observation?
23-hour observation stay
According to CPT,
99218–99220 plus 99217
are for admission and discharge on two separates dates of service, and 99234–99236 are for admission and discharge on the same date of service.
How do I bill G0378?
G0378 must be billed with
revenue code 0762
with the number of hours the individual is in an observation status on one line. Providers will not be allowed to bill more than one line of 0762 on the UB-04 Claim Form.
WHAT IS THE REV code for observation?
Observation services are billed under revenue code
762
, with the appropriate CPT/HCPCS code (99217-99220 and 99234-99236.)
How many hours can you bill for observation?
Observation hours
Not expected to exceed
48 hours in
duration. Greater than 48 hours in duration are seen as rare and exceptional cases. Cover up to 72 hours if medically necessary.
How many days will Medicare pay for observation?
If an observation patient needs skilled nursing facility (SNF) care, Medicare won’t pay. The key is something called the three-day rule. If a Medicare recipient is admitted to a hospital for three days, Medicare will fully pay for post-discharge SNF care for
up to 20 days
, and partially pay for an additional 80 days.
What is place of service code 24?
| Place of Service Code(s) Place of Service Name | 23 Emergency Room – Hospital | 24 Ambulatory Surgical Center | 25 Birthing Center | 26 Military Treatment Facility |
|---|
What are observation codes?
Initial Observation Care codes (99218 – 99220) are
used to report E&M services provided to patients designated/
admitted as “observation status” in a hospital to determine whether they warrant admission, transfer, or discharge. Only the physician initiating observation status may report these codes.
What is a 23 hour hospital stay?
23-hour stays allow the patient management team to observe a patient with signs of a condition
(e.g., stroke, AMI, haemorrhage) that would require hospitalisation for a prolonged period of time
; because the patient is admitted for < one day, all the services are billed at higher rates than would be allowed by the DRGs, …
Does G0378 need a modifier?
In addition, the E/M code associated with these other services must be billed on the same claim form as the observation service and the E/M must be billed with a
modifier -25
if it has the same date of service as the observation code G0378.
What is the difference between G0378 and G0379?
G0379 indicates to Medicare that the patient arrived as a direct admit, but it does not count as the first hour. G0378, on the other hand,
tells Medicare how long the patient stayed in observation
.
What is CPT code G0378?
Observation Services (HCPCS code G0378)
Report HCPCS code G0378 (
hospital observation service, per hour
) under the appropriate revenue code (0762) with units that represent the hours in observation care (rounded to the nearest hour).
What is the CPT code for hospital observation?
Observation or Inpatient Hospital Care (including admission and discharge) CPT codes
99234-99236
are used to report observation or initial hospital services for a patient that is admitted and discharged on the same date of service.
What type of bill is used for an observation claim?
Therefore, hospitals should bill
HCPCS code G0378
when observation services are provided to any patient in “observation status,” regardless of the patient’s condition. The units of service should equal the number of hours the patient is in observation status.
What is Revenue Code 710?
In its answer, Noridian stated to
report charges for recovery room costs
under revenue code 710. Note that the following guidance was issued from a specific FI; please consult with your own FI before altering billing practices in your hospital.
