E/M Coding Alert - 2014 Issue 15
Observation Coding: Medicare Observation Services Increased by 100 Percent, Report Reveals
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Article Overview
This article discusses a reported increase in Medicare hospital observation services and the resulting attention to observation coding accuracy. It is intended for coding professionals, billers, and compliance-focused staff who need a general understanding of observation care reporting, related evaluation and management categories, and how observation claims may be viewed more closely by payers. The article also includes broad examples involving hospital observation and associated diagnosis reporting.
Why This Topic Matters
Observation services have drawn more payer scrutiny as their use has increased, making accurate reporting important for compliance and claim integrity. Readers can use the article to orient themselves to the main observation care categories and the kinds of coding scenarios discussed in hospital settings.
Article Sections
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Observation services growth and payer scrutiny
Introduces the reported increase in Medicare hospital observation services and explains why this trend may affect claims review and documentation attention.
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Initial observation care: timing and severity
Covers general factors involved in initial observation care reporting and presents a brief clinical example in a hospital setting.
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Same-day discharge after observation
Discusses the broad scenario in which observation begins and ends on the same date, with emphasis on how elapsed time and service structure are addressed.
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Subsequent observation care across multiple days
Reviews the general reporting framework for observation stays that continue beyond the initial day and end on a later discharge day.
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Illustrative observation coding example
Provides a second hospital-based example involving observation care and related evaluation and management reporting considerations.
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Resource reference
Points readers to an external report related to Medicare observation services.
What You Will Learn
- How the article frames the growth in Medicare observation services
- What broad observation care reporting topics are discussed
- How same-day and multi-day observation scenarios are distinguished at a high level
- What kinds of hospital observation examples are included
- Which general code sets and service categories are referenced in the discussion
Who Should Read This
- Medical coders
- Outpatient facility billing staff
- Compliance and audit staff
- Revenue cycle professionals
- Physician practice administrators
Codes Discussed
Code Ranges Discussed
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