You inquired about optimizing reimbursement for these boarders. We utilize "observation" codes in lieu of E&M codes for those patients that are admitted to "observation" status for 8-23 hrs, until their final disposition can be determined. The RVU's for the 99217-9 & 99234-6 series is significantly higher than the corresponding 99281-5 codes. Examples of such diagnoses would be ''wheezers," SCD with pain &/or fever, D&D, Undifferentiated ABP etc.

There is additional documentation involved with use of these codes. However, since your staff are responsible for these patients until their status is sorted, this is an option that you could exercise. However, as Sandy suggested, if care is promptly transferred to the inpatient service attending, you would not be able to be avail of this opportunity. 

The first step would be to run some financial projections based on your anticipated census of patients that are typically DC'd within 24 hrs and your average collections/RVU. I would be glad to assist you off the air.

Take care,

Jay Pershad,
Le Bonheur


From: "Rahman, Wassam" <[log in to unmask]>
Are there any "legal" billing or coding tricks to optimize reimbursement
for managing these patients till admission?  Or if of when they end up
being discharged from the ED?

Any input or ideas on how you handle these patients would be

Wassam Rahman, M.D.

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