ED Medical Coding Guidelines: Use G Codes for Simpler Observation Coding


G0378 is a HCPCS code that you would put on the chart that would tell Medicare when you do the G0378 or G0379 in addition to your 99284 or 99285, it tells them this is going to be hospital observation per hour in addition to ED clinic or critical care service. And that's a status indicator. And that can be packaged. So, you know, you just get these codes on there and you let Medicare do the rest.

G0379 is the HCPCS code the you apply when it's a direct admit to hospital observation. And again, that's not going to happen through our emergency department very frequently. We're going to do a work up on these patients and provide an ED E/M or critical care level. So, you want to watch for that.

Now, some of you may be executing medical coding in the clinic areas and you may qualify for the Level I observation. So, that's - you kind of want to revisit the medical coding rules on that as well. For the Level I extended assessment and management composite again, that Level I is assigned by the OCE based on the other codes that you put on there.

High level clinic visit or direct admission to observation, eight or more units of G0378. So what does that tell you? You have to make sure you get in your units your hours. So, for those of you doing medical coding, you have to make sure that it's eight units of the G0378 or eight units of G0379, which translates to your hours.

Nov 26, 2019
Jill M. Young
Nov 27, 2019
Jill M. Young
Dec 3, 2019
Stacie L. Buck
Dec 4, 2019
Stephanie Thomas
Dec 5, 2019
Peggy Slagle

Again, eight or more units of G0378 billed the same day or after CPT 99284, 99285 or 99291 and all other criteria has to be the same, and that's basically that meet the 99284, 99285 criteria, et cetera. OCE assigns it. It's all done magically. Isn't that wonderful?

Note that for observation, physician order to place patient in observation of the evaluation of the patient throughout observation, documentation and observation are relating to that patient through put, if you will, that patient episode and course.

Beginning and end times, very, very important, must have beginning and end times in order to track the hours. It can't just be the hours of the patient is under your care, it has to be hours they're in observation or under observation. So, be careful for that.

And there are really no other changes in these documentation requirements or the medical coding and billing requirements for this. So, this is something you want to kind of keep your eyes on.

G0378 is assigned and it's status indicator “N”. Its payment is always packaged. It's really just an indicator for Medicare to know that you've provided that service in addition to  84, 85 and then keys the payment.

The OCE evaluates every claim received. And what it does is it goes through and looks for the presence or absence of these codes to determine how you're paid. And if you don't have the right combination on there, it will default to your other services that are billed.

Coding and Compliance Tip: So, let's say you don't get your G code on there but you just had your 84 and you don't get your G code on there. The claim will default to just the 84, not the observation an any other surgical procedures or other procedures that are in there as long as they're payable.

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