Health Information Management

Q/A: Billing observation and condition code 44

APCs Insider, October 15, 2010

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Q: An inpatient is converted to outpatient status using condition code 44. Assuming the patient meets the requirements for condition code 44, how should we bill for hours of monitoring and nursing care prior to an observation order being written?

A: In the October 2010 update to the OPPS, Claims Processing Manual Transmittal 2061, CMS revised Chapter 1, Section 50.3.2, adding instructions for billing in this scenario. The hours of monitoring and nursing care prior to an observation order in this scenario should be billed on a separate line with revenue code 0762 (observation hours) without a HCPCS code, with the units representing the number of hours provided.

Hours of observation following a physician order for observation would be billed on a separate line with revenue code 0762, HCPCS code G0378 (hospital observation service, per hour), and the appropriate number of hours following the physician’s order.



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