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Carving out Observation Time


Question

We are wondering if we should carve out time on OBS patients when they leave the floor for radiology procedures such as MRI, CT, and US.  Our thinking is unless a nurse from the floor is accompanying the patient, they are no longer being monitored in "OBS."

Answer

There’s not a clear answer from Medicare.  I suggest you contact your intermediary to determine if they can give you any guidance. Noridian published this guidance "Any separately billed ancillary service that requires ongoing monitoring/attendance would be subtracted from observation. This could apply to injections, infusions, labs and imaging studies that require constant attendance. If an ancillary service, such as an IV push medication is administered while the patient is in observation and billed, providers must subtract the time involved in the injection from observation hours. (The CPT descriptor requires constant attendance of a nurse during the IV push injection). If a patient is sent for an imaging procedure with an observation nurse, the time could be included in the observation hours. However, if a patient leaves the observation area, sent without a nurse for a study or "goes for a smoke", providers should not bill the time. The patient would simply be absent from observation."


Disclaimer: All articles intended for general guidance only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
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Comments (1) Comments
Comment By Bryan Jennings - Wed, Aug 22nd, 2012 4:03 PM
Excellent sources for observation carve outs is Medicare Claims Processing Manual 100-04, Chapter 4, Section 290.2.2 and Noridian Teleconference from April of 2012.Per both these sources Medicare
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