![]() G0379 may be reported with only one unit and must be billed in conjunction with G0378. HCPCS code G0379 is used when an individual is referred directly to observation care after being seen by a practitioner in the community and without an associated Emergency Room (ER) visit, hospital outpatient clinic visit, or critical care service on the same DOS as the initiation of observation care. Providers will not be allowed to bill more than one line of 0762 on the UB-04 Claim Form. HCPCS code G0378 must be billed with revenue code 0762 and the units equal the number of hours the individual is in an observation status. When both the 0762 and 072x revenue codes (excluding 0723) are billed on the same claim the claim will be rejected to the provider. Observation services may not be billed on the same claim as pre-labor monitoring services on revenue code 072x (excluding 0723). Hospitals should not report the CPT codes for physician observation when reporting hospital observation services on the UB-04 Claim Form. Hospital observation must be reported with the HCPCS codes G0378 (Hospital Observation Services, Per Hour) and G0379 (Direct Admission of Patient for Hospital Observation Services). The Healthcare Common Procedure Coding System (HCPCS) observation codes must be used when billing on the UB-04 Claim Form. Hospital observation codes should be reported whether the observation service is separately payable or packaged. Practitioners providing observation care may report a valid observation E/M CPT code for the professional service(s) on a CMS-1500 Claim Form when the patient is not subsequently admitted as an inpatient on the DOS. Similarly, all related E/M services, including observation care, provided on the same DOS by the same performing provider are considered integral to an Inpatient E/M admission code. Providers billing for unrelated E/M services provided on the same DOS by the same performing provider must append modifier 25 when the service is separately distinct and unrelated to the observation care. Professional ProvidersĪll related Evaluation and Management (E/M) services provided on the same date of service (DOS) by the performing provider are considered integral to the observation care E/M code. Observation services are commonly ordered for a patient who presents to the Emergency Department (ED) and who then require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge. Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short-term treatment, assessment, and reassessment, that are furnished while a decision is being made regarding whether a patient will require further treatment as a hospital inpatient or if the patient is able to be discharged from the hospital. PolicyīCBSND follows the observation guidelines outlined in the Current Procedural Terminology (CPT) Manual. This policy provides direction on Blue Cross Blue Shield of North Dakota (BCBSND) reimbursement guidelines for Observation Services.
0 Comments
Leave a Reply. |