Question

.3. The physician evaluates a 68-year-old new patient who was admitted to Observation status earlier today. According to the family, the patient complained about headaches and blurred vision last week and then became confused and disoriented two days ago. The physician performed a comprehensive history and exam, at which time he noted decreased response to light in one eye and BP of 220/100, but the family denied any previously known or treated hypertension. Suspicious for increased intracranial pressure, medical decision making is listed as high complexity. The patient had a CAT scan of the brain without contrast that was positive for brain lesions. An A-scan bilateral ophthalmology biometry was then performed, and patient was sent to the radiology department for simple therapeutic radiology treatment planning. Although the patient has been admitted to Inpatient Observation, he isn't considered a hospital inpatient. How will the outpatient coder report these services?

Answer 1

Answer:

How will the outpatient coder report these services?

The 68-year-old new patient has been admitted to Inpatient Observation, he isn't considered a hospital inpatient, but CPT codes 99218-99220, need to be considered if this initial observation care, includes physician visits during the patient's stay in this status. By the other hand CPT codes 99234-99236, also includes observation or inpatient care, if the patient is determined to be in observation status or admitted to inpatient status and discharged that same day.

Explanation:

According to Medicare every patient who receives a service at the CAHs, shall get a Medicare Outpatient Observation Notice, no later than 36 hours after observation services as an outpatient begin.

The time frame when the doctor  orders “observation services” before deciding to be admitted to the hospital as an inpatient or discharged, is for the patiente to be considered an outpatient.