Place of Services: Hospital Observation and Inpatient

Question 1

A patient is considered OBSERVATION STATUS IN A HOSPITAL when

Answer 1

the physician is unsure if the patient’s condition requires further care by: means of admission or can safely be discharged home.

Question 2

A patient may remain in Observation Status in a Hospital for a

Answer 2

maximum of 48 HOURS (According to CMS Guidelines)

Question 3

INPATIENT CARE

Answer 3

when a patient is ADMITTED into a HOSPITAL or SIMILAR MEDICAL FACILITY for 48 HOURS for the purposes of treatment.

*May last one or more days
*May be preceded by a period of observation

Question 4

FACTORS THAT ALTER the USE OF INPATIENT CARE CODES

Answer 4

*Patient 28 days old or younger (neonate): 99477

*Initial Inpatient Encounter Performed by someone Other than the Admitting Physician:

Consultation Codes: 99252-99255

Subsequent Hospital Inpatient or Observation Codes: 99231-99233

*Admitted and Discharged on the Same Day: 99234-99236

Question 5

• Services 90 minutes or longer during Initial Hospital Inpatient or Observation
  Care

*Services 65 minutes or longer during Subsequent Hospital or Observation Care

Answer 5

Use Prolonged Services Code: 99418:
for each additional 15 minutes of total time

*99418 should always be used as an ADD-ON CODE to CPT CODES: 99223 and 99233

Question 6

Quick Reference Chart

Question 7

Discharge Codes

Answer 7

Used when a patient is cleared to leave the hospital after a period of observation and/or treatment

*Codes Include:
final examination of a patient
prescriptions
discharge records

Question 8

Coding Discharges

Answer 8

Note the:
*AMOUNT OF TIME for the procedure because that DETERMINES WHAT CODE IS USED

*Codes NOT USED when patients are admitted and discharged on the same day (if that occurs use codes: 99234-99236)

*Parenthetical’s underneath code descriptors for addition contraindications and alternate codes