Palmetto GBA - JJ Part B - Are observation codes submitted by the hour or by the calendar date?

We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.

Published Date:03/01/2021

Printed Date: 9/22/2015

URL: http://palmgba.com/marlowe/redesign6/article.html

Are observation codes submitted by the hour or by the calendar date?

Answer
Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began.

Payment for a subsequent observation care code is for all the care rendered by the treating physician on the day(s) other than the initial or discharge date.

Observation Codes Scenarios	Reporting Requirements
Observation Care for less than eight hours on the same calendar date	Report an initial observation, CPT code from code range 99218–99220 Observation care discharge service, CPT code 99217 cannot be reported
Admission for observation care followed by discharge on a different calendar date	Report an initial observation, CPT code from code range 99218–99220 along with Observation care discharge service, CPT code 99217
Observation care continues for three days	Report an initial observation care CPT code from code range 99218-99220 for the first day of observation care; Report a subsequent observation care CPT code from code range 99224–99226 for the second day of observation care; and Report observation care discharge CPT code 99217 for observation care on the discharge date
Observation care continues beyond three days	Report a subsequent observation care CPT code (992249–9226) for each day between the first day of observation care and the discharge date
Observation care is received for a minimum eight hours, but less than 24 hours, and discharge occurs on the same calendar date	Report an observation or inpatient care services (including admission and discharge services) from CPT code range 99234–99236 Observation care discharge service, CPT code 99217 cannot be reported

Resource: CMS IOM 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.8 (PDF, 1.1 MB).

Last Updated: 03/01/2021

Related Articles

Jump to:

Was this article helpful?

That's great!

They can't all be winners right?

Related Articles

Return to Full List Jump to:

Was this article helpful?

That's great!

They can't all be winners right?

Jump to: