Health Information Management

Q&A: Coding for observation

JustCoding News: Outpatient, December 14, 2011

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QUESTION: We have some questions about coding for observation services. Should we still report HCPCS code G0378 (hospital observation services, per hour)? When should we bill the per-day observation charges instead of the per-hour charges? Is the per-day based on 24 hours or a calendar day?

ANSWER: Code G0378 is valid for 2011. Whether you should report this code depends upon the documentation.

The specific third-party payer to whom you are submitting the claim must answer the question of whether to charge the per-day observation charges instead of the per-hour charges. This typically varies among payers.

In virtually all cases, payers interpret “per-day” as measured by date-of-service, therefore, calendar day, not a 24-hour period. Round the amount of time to the nearest hour.

For example, if a patient was in observation from 4 p.m. to 6:45 p.m., report code G0378 x 3. If a patient was in observation from 5 p.m. to 7:20 p.m., report G0378 x 2. Bill all hours on the same line for a single date of service using the date observation services began.

Observation time begins when the physician orders observation services and ends when all medically necessary services related to the observation are complete. Observation can end before the patient leaves the facility if the patient is waiting for a ride home, for example—do not report as observation the hours the patient spends waiting.

Editor’s note: Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

Need expert coding advice? Submit your question to Senior Managing Editor Michelle Leppert, CPC-A, at mleppert@hcpro.com, and we’ll do our best to get an answer for you.



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