99224, 99225, 99226 Solve 'middle Day' Code Confusion

By Author: Angela Martin
Total Articles: 206
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In the coming year, when reporting the middle day of observations that last longer than normal, you will have a new option. Read on and find out how CPT additions will impact your ob-gyn's observation care services beginning on January 1, 2011.


Just-in codes offer clarity


Prior to 2011, coding for the 'middle days' of an observation service was a troublesome affair. Even though not the norm, there are situations where a patient is admitted to observation and remains in that status for three or more days. The CPT 2011 E/M section addresses these middle days with new codes. These new codes parallel the hospital subsequent care series in terms of component requirements and time frames. The new codes include: 99224, 99225 and 99226.


99224-99226 stamp out insurer variances


There has been some complexity about the ways to report the middle day for those cases when an observation period transcends three calendar days. The introduction of these just-in CPT codes resolves that predicament. Before guidance for these 'extended' observation and middle day observation ...
... stays created some confusion and led to various policies such as the Spring 1993 edition of CPT Assistant, which instructed coders to use the unlisted evaluation and management service code to report these services. Payers often took their own path, however when setting policy on 'middleday' observation coding. Payers would often call for 99499; however some carriers preferred 99231-99233 or 99211-99215.


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