Carve out active monitoring time to bill observation appropriately
Case Management Monthly, March 1, 2011
The official length of a professional football game is 60 minutes, but anyone who watches the game on Sunday knows a game beginning at 1 p.m. typically ends around 4 p.m. The various stoppages in play and television commercials add to the overall duration of the game, but the action on the field only occurs for 60 minutes.
The same idea can be applied to observation services. Patients may be in the hospital for several hours, but when you subtract the time patients spend waiting for transportation or undergoing procedures that require “active monitoring,” the billable observation time is reduced.
Observation services are a specific set of services provided to a patient while the physician decides whether to admit or discharge the patient. That means if a patient undergoes a procedure that requires “active monitoring,” he or she is not receiving observation services during the procedure.
Hospitals must subtract the procedure time from observation time to bill correctly. Chapter 4, section 290.2.2, of the Medicare Claims Processing Manual states the following:
Observation services should not be billed concurrently with diagnostic or therapeutic services for which active monitoring is a part of the procedure (e.g., colonoscopy, chemotherapy). In situations where such a procedure interrupts observation services, hospitals would record for each period of observation services the beginning and ending times during the hospital outpatient encounter and add the length of time for the periods of observation services together to reach the total number of units reported on the claim for the hourly observation services HCPCS code G0378 (Hospital observation service, per hour).
However, successfully carving out active monitoring time isn’t easy, according to Deborah K. Hale, CCS, president of Administrative Consultant Service, LLC, in Shawnee, OK. CMS does not officially endorse any method for counting observation hours and carving out active monitoring time, Hale says. “In fact, CMS leaves lots of gray areas. Hospitals are taking their best guess and moving ahead,” she says.
- Study: Almost half of nurses are thinking about leaving the profession
- Fracture coding in ICD-10-CM requires greater specificity
- What does case-mix index mean to you?
- Complications from immobility by body system
- Differentiate between types of wound debridement
- Pneumonia with a negative chest x-ray: Clinical diagnoses, physician documentation, and coding guidelines
- OB services: Coding inside and outside of the package
- Don’t forget the three checks in medication administration
- What is the difference between an IPA and a medical group?
- Note similarities and differences between HCPCS, CPT® codes
- Bill and charge for supplies correctly to reduce risk and minimize lost revenue
- Seven tips for slashing ED wait times with limited resources
- QA:Coding multiple initial infusions
- Q&A: Query for "Type 2 injury"
- Q&A: Coding using suspected, probable diagnoses
- Q&A: Coding for transplant complications
- Note from the Instructor: Review of hospital inpatient mental health services payable under the inpatient psychiatric facility prospective payment system (IPF PPS)
- Increase patient satisfaction by improving your discharge process
- HIPAA Q&A: Maintenance of medical records after physician death
- Don't underestimate the importance of good documentation