Understanding Hospital Inpatient and Observation Care Services (Including Admission and Discharge)
When it comes to patient care in hospitals, it's essential to have a clear understanding of how inpatient or observation care services are categorized, especially when admission and discharge occur on the same or different dates. In this blog, we break down the different codes used for reporting such services, helping you understand the regulations and procedures behind hospital stays.
What Are Inpatient or Observation Care Services?
Inpatient and observation care services are procedures provided to patients admitted to the hospital and discharged on the same day. These services are reported when the stay exceeds eight hours and must be conducted by a physician or other qualified health care professional. The professionals involved in these services will handle both the admission and discharge, using codes 99221, 99222, or 99223, depending on the case.
Reporting for Stays Less Than Eight Hours
When a patient’s stay is less than eight hours, different rules apply:
Only the initial hospital inpatient or observation care codes (99221, 99222, or 99223) may be reported for the admission date.
Hospital observation discharge codes 99238 and 99239 are not reported when the stay is less than eight hours.
Reporting for Stays of Eight Hours or More
For stays that last eight hours or more, there are separate sets of codes for admission and discharge:
Codes 99234, 99235, and 99236 are used for services when the patient is admitted and discharged on the same calendar date.
If the patient is admitted and discharged on different dates, codes 99221, 99222, or 99223 (initial services) should be combined with 99238 or 99239 (discharge services).
Key Scenarios for Reporting Codes
The following table summarizes how to select the correct codes based on the length of stay and discharge timing:
Length of Stay | Discharged On | Report Codes |
Less than 8 hours | Same calendar date as initial inpatient or observation service | 99221, 99222, or 99223 |
8 or more hours | Same calendar date as initial inpatient or observation service | 99234, 99235, or 99236 |
Less than 8 hours | Different calendar date than initial service | 99221, 99222, or 99223 and 99238, 99239 |
8 or more hours | Different calendar date than initial service | 99221, 99222, 99223 and 99238, 99239 |
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Important Notes:
Codes 99234, 99235, and 99236 require two or more visits on the same day, including one for initial admission and another for discharge.
For patients admitted and discharged on the same visit, ensure proper reporting by using codes 99221, 99222, or 99223.
Do not use 99238, 99239 in conjunction with 99221, 99222, or 99223 if the admission and discharge occur on the same day.
Multiple-Choice Practice Questions
1. Which code should be used when a patient is admitted for inpatient care and discharged on the same calendar day after a stay of 6 hours?
A) 99221B) 99234C) 99238D) 99236
2. If a patient stays in observation for 10 hours and is discharged on the same calendar day, which of the following code sets should be reported?
A) 99221 and 99238B) 99234, 99235, or 99236C) 99238 and 99239D) 99221 only
3. Which of the following is true regarding the use of code 99238?
A) It can be used when the patient’s stay is less than 8 hours.B) It is reported only when the patient is discharged on the same day as the admission.C) It is used only for discharge services.D) It can be reported along with 99234 for the same-day discharge.
4. What should be done if a patient is admitted and discharged on different calendar dates, with a stay of less than 8 hours?
A) Report only the admission code.B) Report both an initial admission code and a discharge code.C) Use code 99234 for both admission and discharge.D) No codes need to be reported for this scenario.
5. When should codes 99234, 99235, or 99236 be used?
A) When a patient is admitted and discharged on the same calendar date after a stay of at least 8 hours.B) When a patient is admitted and discharged on different calendar dates after a stay of at least 8 hours.C) When a patient is admitted and discharged on the same calendar date after a stay of less than 8 hours.D) When the discharge is handled by a different physician. Understanding Hospital Inpatient and Observation Care Services (Including Admission and Discharge)
Answers and Rationale
1. A) 99221
Rationale: Since the stay is less than 8 hours, only the initial admission code (99221) should be reported.
2. B) 99234, 99235, or 99236
Rationale: For stays of 8 hours or more with admission and discharge on the same calendar day, these codes are used.
3. C) It is used only for discharge services.
Rationale: Code 99238 is specifically for hospital discharge services and should not be used for admission.
4. B) Report both an initial admission code and a discharge code.
Rationale: If the patient is admitted and discharged on different calendar dates, both the initial service code (99221, 99222, or 99223) and the discharge service code (99238, 99239) should be reported.
5. A) When a patient is admitted and discharged on the same calendar date after a stay of at least 8 hours.
Rationale: Codes 99234, 99235, and 99236 are used when the patient’s stay lasts for 8 or more hours and the admission and discharge occur on the same calendar day.
Important Notes:
Codes 99234, 99235, and 99236 require two or more visits on the same day, including one for initial admission and another for discharge.
For patients admitted and discharged on the same visit, ensure proper reporting by using codes 99221, 99222, or 99223.
Do not use 99238, 99239 in conjunction with 99221, 99222, or 99223 if the admission and discharge occur on the same day.
Conclusion
Proper reporting of hospital inpatient and observation care services is essential for accurate billing and compliance with medical coding standards. Physicians and healthcare professionals need to be aware of the codes corresponding to the length of stay and the date of discharge to ensure the services are accurately reported. Whether the patient’s stay is shorter or longer than eight hours, the guidelines and rules mentioned here provide a clear framework for selecting the correct codes.
Jen's ICD Notes available below!
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