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Clip and Save: Your APC 0339 Cheat Sheet

A handy reference for observation reporting
The OPPS requirements for observation payment may have eased up, but you still have to remember certain crucial details to get reimbursed for these services: 
The admitting or primary diagnosis code needs to be for chest pain, asthma, or congestive heart failure.
 
Your facility's bill needs to include an evaluation and management code in addition to the observation G code. That E/M code can come from the emergency department, clinic, or critical care, as long as it's on the bill.
 
Remember: You need to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.
 
To report G0244 (Observation care provided by a facility to a patient with CHF, chest pain, or asthma, minimum of 8 hours), you need to have at least eight hours in the "unit" field of the UB-92 form.
 
You can't include any procedures with a "T" status indicator, except for infusion therapy.
 
Make sure the observation time appears clearly in the documentation.
 
The patient must be under a physician's care.
 
The documentation must show that the doctor explicitly assessed the patient's risk and determined that observation care would be beneficial.

Information provided by Lisa Marks, RHIT, CCS, with Precyse Solutions.


- Published on 2005-03-22