Provider Notice Issued 12/09/2016

Date:   December 9, 2016

To:       All Enrolled Hospitals:  Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Ambulatory Surgical Treatment Centers (ASTCs)

Re:      Billing Instruction Changes for Observation Services  

This notice identifies observation billing instruction changes for hospitals and ASTCs.

Effective with dates of service beginning July 1, 2014, the Department has required that procedure code G0378 be billed in combination with one of the following Evaluation and Management codes on claims for observation: 99218, 99219, 99220, 99234, 99235, or 99236. To be in compliance with recent National Correct Coding Initiative (NCCI) edits, the Department can no longer require the Evaluation and Management procedure codes to be billed in combination with G0378 on claims for observation. New national requirements authorize G0379 to be billed with G0378 instead of the Evaluation and Management codes.

·       For service dates billed through December 31, 2016, providers must continue using the Evaluation and Management procedure codes with G0378.

·       Effective January 1, 2017, for dates of service April 1, 2016 through December 31, 2016, providers have the option to bill the Evaluation and Management codes with G0378, or may bill G0379 with G0378.

·       For service dates beginning January 1, 2017, all observation claims received by the Department must be coded with G0379 and G0378 according to the revised NCCI requirements or the claims will be rejected. Providers must continue to identify two revenue lines for observation, with the first Revenue Code 0762 billed with G0379, and a second Revenue Code 0762 billed with procedure code G0378.

These coding requirements also apply to claims with Medicare Part B as the primary payer (Medicare crossovers).

The last pages of the Ambulatory Procedures Listing have been updated to reflect the procedure coding changes. Any questions may be directed to a medical assistance consultant in the Bureau of Hospital and Provider Services at 1-877-782-5565.

Felicia F. Norwood

Director