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Re: OBSERVATION VISITS From: Anna Meenan, MD (annam@uic.edu) Wed Aug 13 20:45:27 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Anna Meenan, MD: "Re: FRI: George Carlin" Previous message: DMECNM@aol.com: "Re: FRI: George Carlin" In reply to: Wilma Harrell: "OBSERVATION VISITS" Next in thread: D. Ashley Hill, MD: "Re: OBSERVATION VISITS" Reply: D. Ashley Hill, MD: "Re: OBSERVATION VISITS" Reply: Garry E. Siegel, M.D.: "Re: OBSERVATION VISITS" OK, here is how I would look at this, if it occurred at my hospital, which it doesn't. If coded as an outpt. visit, this would code out to be a 99213, or 0.67 RVU's (you can't code it based on time spent at bedside if it's an outpt. visit, since you didn't spend >50% of the visit doing counseling and coordination of care). If coded as an observation visit, it would code out as a 99218, or 1.28 RVU's. Since most OB pt's are relatively healthy and you often know quite a bit of their history already or have a prenatal on file with all of it already recorded, doing a quick H&P shouldn't add much more than 5 minutes to the visit, ten max. Since you've already hauled your butt up to the hospital, why not get paid better for a few more minutes of work? That's how I would look at it. BTW, I haven't seen your name on the forum before. Introduce yourself if you're new, and welcome to the List. -- Anna Meenan, MD, FAAFP At Wed, 13 Aug 2003, Wilma Harrell wrote: > >ALL patients who present to L&D on the weekends and weekday nights are >admitted as "observation". I don't know why, but this is what occurs. >It does not matter how trivial the complaint is, or how quickly it is >resolved...ALL are admitted to "observation" as a matter of protocol. >Who made the protocol is another question. >A 16 yo who is full term presents for vaginal itching. An NST is >automatically performed (protocol). I arrive at the psatient's bedside, >perform a speculum exam, confirm a yeast infection, and interpret the >NST. I spend 20 minutes at the patient's bedside. >IF THE PATIENT IS TRULY "OBSERVATION" THEN I CANNOT BE PAID UNLESS I >DICTATE AN ENTIRE H&P FOR A RIDICULOUS YEAST INFECTION. IF THIS PATIENT >IS CALLED "OBSERVATION" BUT IS ACTUALLY AN "OUTPATIENT" I CAN DICTATE A >SIMPLE NOTE INCLUDING THE TIME SPENT AT THE BEDSIDE AND CHARGE AN >"OUTPATIENT" CODE. >These ridiculous situations are endless. The list goes on and >on...yeast infections, heart burn, nausea, headache. None of these >20-30 minute visits necessitate an H&P. Why should I have to jump >through these hoops? >Is it incorrect to label each patient (no matter what) as observation? >Is it incorrect to call it "observation" when it's really just an >"outpatient" type visit? >For the purposes of medicaid, can these be billed with "outpatient" >codes inspite of the "observation" misnomer? Next message: Anna Meenan, MD: "Re: FRI: George Carlin" Previous message: DMECNM@aol.com: "Re: FRI: George Carlin" In reply to: Wilma Harrell: "OBSERVATION VISITS" Next in thread: D. Ashley Hill, MD: "Re: OBSERVATION VISITS" Reply: D. Ashley Hill, MD: "Re: OBSERVATION VISITS" Reply: Garry E. Siegel, M.D.: "Re: OBSERVATION VISITS"

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