AHA Coding Clinic® for HCPCS - 2022 Issue 3; Ask the Editor

Reporting observation status in the emergency department

A patient with a history of mental health issues is seen in the Emergency Department (ED) for agitation and suicidal thoughts. History reveals the patient has been noncompliant with medications for two weeks. The patient is severely decompensated with hallucinations and suicidal ideation. The patient reports one prior suicide attempt. Examination reveals signs of self-mutilation to both arms. The emergency physician treats the patient and screens for alcohol and substance abuse. The patient is medically cleared and referred to a mental-health counselor for evaluation in the ED. After evaluation by the mental-health counselor, it is determined that the patient is at risk of self-injury and a recommendation is made for inpatient psychiatric care. The hospital has no psychiatric beds available, so a search is initiated for an inpatient psychiatric bed. Based on a standardized suicide severity rating scale, the patient initially requires 1:1 observation by hospital staff for suicide watch precautions. A physician reviews the patient’s medical history and restarts the patient’s medications. The patient’s response to medication, counseling and any other treatment are monitored by hospital staff continuously. During outbursts, hospital staff use de-escalation techniques, chemical and physical restraints as required. Any other medical conditions are addressed and staff document the patient’s progress in the medical record. The patient remains at the original hospital until an inpatient psychiatric bed is found on the fourth day. Once accepted, the patient is admitted to the inpatient psychiatric facility.What CPT code(s) should a facility use to report outpatient services provided to a patient over multiple days while waiting for an inpatient psychiatric bed to become available, i.e., based on the above typical scenario? ...

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