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.
