Billing Guidelines for Observation Services
When a managing/attending physician provides service to a member at an observation level of care, the physician should use the following Evaluation and Management codes when billing for these services to ensure accurate processing of the claim:
- 99217, 99218, 99219, 99220, 99234, 99235, and 99236
We recognize the appropriate use of observation services (i.e., observation status and observation level) for patients to monitor and treat medical conditions on an outpatient basis and to evaluate a patient’s need for acute inpatient admission. Observation services are outpatient services that include diagnosis, treatment, and stabilization of patients from a minimum of six to a maximum of 24 hours per InterQual guidelines.
For the complete article, please read the May edition of Partners in Health UpdateSM.
