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Issue Number - Name
0086 - Observation Evaluation & Management (E&M) codes billed Same Day as Inpatient Admission
Review Type
Automated
Claim Type
Professional Services (Physician/Non-Physician; Outpatient Hospital)
Region and State
RAC 1-4
All States
Date Approved
2018-02-13

Description

Medicare payment for the initial hospital visit includes all services provided to the patient on the date of admission by that physician, regardless of the site of service. The physician may not bill observation care codes (initial, subsequent and/or discharge management) for services on the date that he or she admits the patient to inpatient status.

Affected Code(s)

  •  99217, 99218, 99219, 99220, 99224, 99225, 99226, 99221, 99222, 99223 

 Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1833 
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.8 (D)