Billing and Documentation

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  • 1.  Inpatient vs. Observation Status

    Posted 02-10-2023 19:26


    Our hospital is considering admitting OSH ED transfers into Observation Status vs. Inpatient Status.

    For those with experience, any implications for critical care billing or collections?


    Jason Brainard

    University of Colorado

    Jason Brainard
    Associate Professor of Anesthesiology and Critical Care
    University of Colorado School of Medicine

  • 2.  RE: Inpatient vs. Observation Status

    Posted 02-11-2023 19:36

    Out of curiosity, what is the hospital's intention in admitting to observation? I think it would be very difficult to justify that a patient is critically-ill but is not admitted to the hospital unless you want to say that because of your critical care assessment and interventions, the patient was deemed to warrant admission to critical care.


    Ryan Hakimi
    Neurocritical Care
    Director, TCD Services. Chair Pharmacy and Therapeutics Committee
    University of South Carolina School of Medicine-Greenville
    Greenville SC

  • 3.  RE: Inpatient vs. Observation Status

    Posted 02-12-2023 11:58

    Peds ICU here -- we get kids who have ingested some substance / med & though clinically look great, Poison Control recommends CV monitoring, q1 neuro checks, q1 blood glucose. We have no telemetry unit for gen care (only cardiac), so they come to PICU, stay 12-24 hrs, and go home. WE do labs, check EKG, and observe. That's OBS.

    Jana Stockwell
    Professor, Pediatric Critical Care Medicine
    Children's Healthcare of Atlanta, CCM

  • 4.  RE: Inpatient vs. Observation Status

    Posted 02-14-2023 07:35

    As stated in the CMS billing guidelines, location of care or patient status does not dictate critical care billing. I believe, Emergency Departments where patients are not in hospital admission status, have the highest critical care billing by volume. More important is supportive documentation in my opinion.

    Piyush Mathur
    The Cleveland Clinic