decisionhealth Newsletters, Answer Books - 2011 Issue 1 (January)
Observation Care / Observation care after a procedure: Can you bill?
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Article Overview
This article reviews Medicare’s approach to observation care provided after a diagnostic or therapeutic procedure. It is aimed at coders, billers, and compliance staff who need to understand when observation is considered part of the packaged service and what general Medicare policy language governs separate reporting. The discussion focuses on CMS manual guidance and the relationship between observation services, global surgical payment concepts, and selected CPT modifiers.
Why This Topic Matters
Observation services after a procedure can affect claim reporting and payment, so understanding Medicare’s policy helps reduce avoidable denials and compliance risk.
What You Will Learn
- How Medicare treats observation care furnished after a procedure
- Which CMS policy sources are referenced in the discussion
- The general circumstances under which observation may be considered separately reportable
- How global surgical payment concepts relate to observation care
Who Should Read This
- Medical coders
- Hospital billers
- Revenue cycle staff
- Compliance professionals
- Physician practice administrators
Modifiers Discussed
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