tci ED Coding & Reimbursement Alert - 2005 Issue 4

Know These Payer Nuances for Flawless Observation Coding

Timing, E/M elements are crucial for correct claims Guidelines for reporting observation can be tricky - so if you're confused about when you can report observation services, when you can report an emergency department E/M code, and when you can report both, debunk these common myths before dropping your next 99234 claim. Myth #1: If the physician provides observation care for fewer than eight hours on one calendar date, we can only bill an ED evaluation and management (E/M) code. Reality: Not only can you bill for fewer than eight hours of observation care, but if you're submitting...

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