Q: What observation code is appropriate for patients directly admitted to the facility from a physician’s office, skilled nursing facility, or assisted living facility who do not meet the criteria for payable observation, code G0244?
Compliance Monitor, June 4, 2004
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A: Use code G0264. When patients are directly admitted to the facility from a physician's office, skilled nursing facility, or assisted living facility, there is no clinic or emergency department (ED) code to generate the aforementioned patient. That is why CMS created this code.
This code tells the FI that the patient did not arrive at the facility through a standard point-of-care entry route (i.e., ED or clinic) and that because the patient does not meet qualifications for payable observation, the facility will essentially receive no payment for any E/M services that the facility provided on the technical side. Never code G0264 with an ED or clinic E/M code.
This question was answered by Byron Johnson, RHIA, CPC-H, Senior Consultant at the Wellington Group.
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