tci ED Coding & Reimbursement Alert - 2001 Issue 1

CPT 2001: Medicare Revises Observation and Inpatient Hospital Care Payment Policy

Medicare has revised its payment policy for observation and inpatient hospital care services when the patient is admitted and then discharged more than eight hours later, but still on the same day. Previously, physicians would have reported 99218-99220 (initial observation care, per day, for the evaluation and management of a patient) for this service. But effective Jan. 1, 2001, they should report 99234-99236 (observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date). This is important because codes 99234-99236 have a higher relative value unit (RVU) than codes...

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