CPT® Don't Oversee These 2012 Observation Care Coding Updates

Added time guides will supplement 99218-99220 descriptors beginning Jan. 1.

If you're hardly familiarizing yourself with 2011 novel codes for subsequent observation care 99224-99226, support yourself for a couple of fresh reports about how to report these new codes, and reimburse for your deserved dollars as well as ensure accurate medical coding.

CMS Renders Finality To 99224-99226 RVUs

CPT manual presented codes for subsequent observation care, 99224 (Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity.); 99225 (Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity.); and 99226 (Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity.) beginning Jan. 1, 2011.

CMS denotes that the following value units are certainly final at the disputed levels, and will decide the payment levels for subsequent observation care under the Medicare fee schedule for 2011 and subsequent years:

99224 -- 0.82

99225 -- 1.45

99226 -- 2.17

'Treating Physician' Gets Exclusive Rights To Use 99224-99226

CMS has also specified that only treating physicians can report subsequent observation care. The agency mentions that subsequent observation care pay comprises "all the care rendered by the treating physician on the day(s) other than the initial or discharge date. Any other physicians evaluating or consulting on the observation care patient "must bill the appropriate outpatient service codes," and not the subsequent observation care codes.

Pick Out Appropriate Observation Code Based On Time

As per CPT manual, hospital observation care codes 99224-99226 and 99218-99220/99217 are applicable to an otolaryngologist when a patient gets admitted to observation (as opposed to inpatient), and then gets discharged either on the same day or on two calendar days.

Tell the difference: In case you're puzzled about the distinct functions of 99224-99226 and additional set of observation codes 99218-99220/99217, remember that the difference lie on when the service is rendered/completed.

Codes 99224-99226 in CPT manual describe observation care for a patient who is admitted to and discharged from observation on the same calendar day. In this case you would use only one code from the CPT manual to represent both services of the admission and the discharge from observation.