Observation Codes For Family Practice


 

Observation Codes 99224, 99225, 99226 Help Answer the ‘Middle Day’ Code Question

As per 2011 coding updates, you have a new option when reporting the middle day of extended observation. Before 2011, coding for the middle days of an observation service was a problem. Although not the norm, there are situations where a patient is admitted to observation and remained in that status for three or more days.
The CPT 2011 E/M section addresses these middle day or extended visits with new medical codes. The three new codes parallel to hospital care series in terms of component requirements and time allotment.

So as you see here, the 99224 which is the low level code for the extended observation code matches the history exam and medical decision making component of the lowest level of 99231 for subsequent hospital care.

There has been some confusion about how to report the middle day for those cases when an observation period transcend three calendar days. The introduction of these new medical codes resolves that dilemma.

There has been some confusion about how to report the middle day for those cases when an observation period transcend three calendar days. The introduction of these new codes resolves that dilemma.

Coders and physicians however who are excited about the new subsequent care observation code won't be jumping for joy when they hear the accepted payments for the codes. The Relative Value Update committee had compared the new CPT codes 99224 to 99266 the subsequent hospital care values and have recommended the same work value.

The Center for Medicare however disagreed with the proposal. Instead, to recognize the difference in patient acuity between the two settings, we have removed the pre-imposed service times from the values reducing the values to 75% of the value for subsequent hospital care code. Ken Simmons announced at the AMA, CPT and RBRVS Symposium in Chicago in November.

So as you see here, this is what the proposed value was and these were cut by about a quarter. At first, it was a disappointment with the accepted lower values. But you can't disagree with the rationale that observation services do not have the same diagnostic severity and risk associated with the morbidity between patient physician encounters as hospital care services.

Thus you have to be cautiously agree with the Center for Medicare’s decision. The one of many insurers have list of ICD diagnosis codes that they allow for observation care. If the diagnosis is not on the approved list, your observation care service will be not denied.

For instance, with asthma, some Medicaid programs consider if the patient has exacerbated asthma that is severe enough that the condition cannot be controlled in the office, the patient should be admitted to the hospital and not remain in observation. Make sure that you ask your contractors for such list.

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