Ask a Rev Cycle Expert: Reporting Observation Hours?
Question:
Could you please clarify how to bill observation hours? Are all of the observation hours listed on one line? What if we have more than 72 hours of observation?
Answer:
According to the Medicare Claims Processing Manual, all hours for the period of observation should be submitted on a single line item, with the date of service as the date the observation services began. During the COVID-19 pandemic, the Medically Unlikely Edit (MUE) for HCPCS code G0378 Hospital observation service, per hour has been suspended. After the pandemic, claims with hours of observation over the MUE limit will need to be appealed with the documentation to support medical necessity.
Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).