Report direct 24-hour observation admit with G0379 x1, G0378 x24

Q: Our staff have discussed how to report new observation codes G0378 and G0379, but we remain confused. If we have a direct admission to observation for 24 hours, how do we report the service? Which of the following is correct?

G0379 (Direct admission to observation, initial) x1 unit, and G0378 (Observation services per hour) x24 units

G0379 x1, and G0378 x23 (to equal the 24 hours)

Is G0379 an add-on code or is it included in the total time?

A: The first option is the correct way to bill this encounter: Bill one unit of G0379 and 24 units of G0378. The one unit of G0379 represents more of an E/M-type service that is provided when the patient is directly admitted to observation.

The payment for this code, if it qualifies via the OCE, covers the facility costs related to placing the patient directly in observation (registration, nursing overhead/evaluation related to the initial services provided, etc.).

G0379 indicates to Medicare that the patient arrived as a direct admit, but it does not count as the first hour.

G0378, on the other hand, tells Medicare how long the patient stayed in observation. Think of G0378 (not G0379) as your time-based code. Every time you report G0379, include a line item for G0378—even if the patient is only directly admitted to observation for one hour.

[ via Patient Financial Services Advisor ]

Comments

[Debbie Hagy]

I have a question regarding Bariatric surgery? When a patient comes to an ASC for Lap Banding and it is known at the time the procedure is scheduled that it will be a 23 hour or more observation, should this procedure be scheduled and performed at an ASC? If so, what are the requirements and coding for the observation? Very confused!