Observation Hours Prior to Inpatient Admission

myreddickmyreddick
in BILLING AND CLAIMS
Looking for feedback. How do you report observation hours prior to an inpatient admission?  Or do you report these?  Thanks!

Comments

  • tkoger@wellspan.orgtkoger@wellspan.org
    We charge based upon the physician's order.  Therefore if the patient is in observation for 28 hours and then gets admitted, the claim would have charges based upon the orders and timing events.
  • John.SettlemyerJohn.Settlemyer
    I agree.  By definition, Observation is "active treatment".  All properly ordered and documented OBS time up to the time of an IP order should be included on the IP claim (under UB 0762, no HCPCS).
  • RHirschRHirsch
    John-
    Why no HCPCS? I am assuming there was an order for the Observation. If the patient had observation ordered at 8 am, then was made inpatient at 7 pm when their condition changed, I'd think that the 11 hours of Obs would bill with HCPCS G0378. 
  • John.SettlemyerJohn.Settlemyer
    HCPCS detail are not generally required on inpatient claims.  There very well may be G0378 in the background somewhere on the detailed charges (depends on whether the facility hardcodes the G0378 in the CDM or if HIM appends it based on payer need).  It's just not required coding detail on the IP claim.
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