Medical Billing And Second Observation Day Coding

Medical Billing And Second Observation Day Coding

Eventually, when you’ve done enough medical billing, you will run across the scenario when a patient is in the hospital on a three day stay, a common belief among medical billers is that the a “middle” day of observation should be billed on the medical billing form as an Outpatient Visit (99212-99215).

Many Carriers and Medicare will not reimburse a middle day visit coded in this fashion. Even with documentation for the middle day visit included on the medical billing form.

The AMA’s position on the medical coding for this situation is that you report the middle/second day of a three day stay as observation care with 99499 (Unlisted evaluation and management service), and to make sure your documentation for your medical coding is absolutely accurate, check with your third-party payer because each may have specific policies for the documentation they will require on the medical billing form in order to reimburse the physician, remember this medical billing coding applies to physician reimbursements only, not hospital coding.

So, if a private payer’s policies dictate that you process the medical billing form coding the second day observation as an outpatient service, you may follow its guidelines and report 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient) as applicable. Otherwise, if you can not get clarification or you can not locate policies that specifically dictates the coding should be as above, you should stick with the AMA-backed 99499 for coding your medical billing form.

Remember, unlisted codes can mean a big difference in your partially paid medical billing claims and getting payments on procedures and services that might otherwise be denied. Knowing the difference is the job of your medical billing partner. If you’re not already outsourcing your medical billing, look into it today!

View all Articles by: Melissa Clark, CCS-P