Re: OBSERVATION VISITS
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Wed Aug 13 21:45:48 2003
Anna:
I've not been able to understand the subtle differences in using
observation codes--there are a couple of different categories. Can you
shed some light, either on the forum, or by private email?
I would have coded this as an outpatient E/M, at the level supported by
the history/exam, or more likely, the time element--just as you
suggested.
Also, welcome new physician, and I second what Anna has said: please
take a moment and introduce yourself.
Garry
At Wed, 13 Aug 2003, Anna Meenan, MD wrote:
>
>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?
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
