This is an excerpt of the AMA CPT Assistant – May 2006
Observation Reporting Criteria
2. Observation time
a. Observation time must be documented in the medical record.
b. A beneficiary's time in observation (and hospital billing) begins with the beneficiary's
admission to an observation bed.
c. A beneficiary's time in observation (and hospital billing) ends when all clinical or
medical interventions have been completed, including follow-up care furnished by
hospital staff and physicians that may take place after a physician has ordered the
patient be released or admitted as an inpatient.
d. The number of units reported with HCPCS code G0378 must equal or exceed eight
hours.
3.
Additional hospital services
a.
The hospital must provide on the same day or the day before and report on the bill one
of the following:
1) An emergency department visit (APC 0610, 0611, or 0612)
2) A clinic visit (APC 0600, 0601, or 0602)
3)
Critical care (APC 0620)
4) Direct admission to observation using HCPCS code G0379
b. No procedure with a "T" status indicator can be reported on the same day or day
before observation care is provided.
4.
Physician evaluation
a.
The beneficiary must be in the care of a physician during the period of observation, as
documented in the medical record by admission, discharge, and other appropriate
progress notes that are timed, written, and signed by the physician.
b. The medical record must include documentation that the physician explicitly assessed
patient risk to determine that the beneficiary would benefit from observation care.
CPT Assistant
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