observation care evaluation and management codes - Oxford Health ...

Q3: What code should be reported for a patient who continues to be in observation status fora second date and has not been discharged?A3: A subsequent observation care CPT code (99224-99226) should be reported in theinstance a patient is held in observation status for more than 2 calendar dates. Whenobservation discharge services are provided to the patient, report CPT code 99217 on thatcalendar date. For example, report CPT 99218-99220 for a patient designated as observationon Day 1, report CPT 99224-99226 on Day 2 and finally report CPT 99217 when the patientreceives discharge services on Day 3.Q4: Why are observation codes G0378 and G0379 not addressed in this policy?A4: These HCPCS codes are not to be reported for physician services. These codes are tobe billed by facilities on a UB-04 claim form.RESOURCES/REFERENCESThe foregoing Oxford policy has been adapted from an existing UnitedHealthcare national policythat was researched, developed and approved by the UnitedHealthcare National ReimbursementForum. [2013R0115A]1. American Medical Association. Current Procedural Terminology (CPT®) and associatedpublications and services.2. Centers for Medicare and Medicaid Services, CMS Manual System and other CMSpublications and services.POLICY HISTORY/REVISION INFORMATIONDate04/01/2013Action/DescriptionRoutine review; no change to reimbursement guidelinesUpdated list of applicable HCPCS codes to reflect annual codeedits (effective 1/1/13); revised description for 99217-99221,99224-99226 and 99234-99236Archived previous policy version ADMINISTRATIVE 232.5 T0Observation Care and Evaluation and Management Codes: Reimbursement Policy (Effective 04/01/2013)©1996-2013, Oxford Health Plans, LLC6