ED Coding & Reimbursement Alert - 2008 Issue 16
PART B REVENUE BOOSTER: Don't Write Off Those Pre- or Postop Observation Care Dollars
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Article Overview
This article covers Medicare billing guidance affecting observation care provided before or after surgery, with emphasis on how CMS guidance may allow separate reporting in specific situations. It is aimed at coders, billers, and physician office staff who work with hospital observation, global surgical periods, and evaluation and management coding. The article discusses the general conditions for reporting observation services, the role of modifier selection, and how hospital status and place of service documentation can affect billing.
Why This Topic Matters
Observation care tied to surgical episodes can affect whether services are bundled or reported separately. Understanding the Medicare guidance and documentation considerations can help coding and billing staff avoid missed reimbursement and align physician billing with hospital records.
Article Sections
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Medicare guidance on observation services and the global surgical period
Overview of the CMS guidance discussed in the article and how it relates to observation care around surgical services. The section frames the broader billing context and the types of claims affected.
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Criteria for reporting observation care separately
Discussion of the general conditions described for reporting observation services in connection with a surgical episode. The section emphasizes the need to consider both claim circumstances and supporting documentation.
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Postoperative and preoperative examples
Two brief scenarios illustrate the article’s general themes using postoperative and preoperative observation settings. The examples show how different clinical circumstances can affect billing considerations.
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Hospital records and place of service considerations
Reminder to review hospital status information when physician and hospital billing may differ. The section highlights the importance of record review and place of service alignment.
What You Will Learn
- How Medicare guidance addresses observation care around surgery
- What broad criteria are discussed for separate reporting of observation services
- Why modifier selection is part of the billing discussion
- How hospital records and patient status information affect billing review
Who Should Read This
- Medical coders
- Billing staff
- Physician office managers
- Compliance and revenue cycle staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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