Duplicate Initial Observation Service

Date Issued: 7/16/2018

The following is in accordance with CPT coding guidelines from the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS).

These observation care codes are strictly for the first day of treatment:

  • Initial observation care (CPT codes 99218-99220).
  • Treatment that includes initial observation care (CPT codes 99234-99236).

Treatment that is given on subsequent days should be billed with another code, such as:

  • An observation care discharge (CPT code 99217).
  • Initial hospital visit (CPT codes 99221-99223).

Only one initial observation care code will be allowed throughout a hospital stay. Claims will be denied if codes for the first day of treatment are used for care given on subsequent days.

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