tci ED Coding & Reimbursement Alert - 2003 Issue 10

Reader Question: Report ED E/M Code for Observation Services

Question: Our ED physician admitted a patient to observation and later discharged him. The patient's diagnosis did not meet the facility requirements to apply for Medicare reimbursement, so the hospital didn't report code G0244 (Observation care provided by a facility to a patient with congestive heart failure, chest pain, or asthma, minimum 8 hours, maximum 48 hours). Can we bill for the physician's professional services in observation even though the patient didn't meet Medicare criteria on the facility side?       Georgia Subscriber Answer: The hospital can only bill Medicare for observation services when the...

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