Remember these guidelines when billing for observation services

When billing hospital observation services, please remember to:

• Report the total number of hours of observation care. BCBSM covers up to 48 hours of observation care.
• If a patient is admitted to observation from the emergency room, report all observation hours on one claim line with G0378, using the first date of service the patient entered observation care.
• If a patient was directly admitted for observation care from another setting, report all observation hours on one claim line with G0379, using the first date of service the patient entered observation care.

For observation services, see the following billing instructions and examples for admissions to observation from the emergency room and direct admissions to observation from another setting.
Example — Outpatient medical emergency and observation room spanning more than 48 hours
Type of bill (Form Locator 4)
Type of bill “0131” indicates hospital outpatient claim.
Revenue codes (Form Locator 42)
Revenue code "0450" indicates emergency room, and revenue code "0762" indicates observation room.
HCPCS codes (Form Locator 44)
Required for all observation, laboratory, radiology and surgery services. Report G0378 with total number of observation hours and charges. BCBSM covers up to 48 hours of observation care.
Service units (Form Locator 46)
The number of hours spent in observation is required in the service unit form locator when revenue code "0762" is reported.

When a patient stays in the emergency room or observation more than 48 hours or spans two or more calendar days, report the “from” and “through” dates that reflect the patient’s entire stay.

Any observation, laboratory, drug, radiology services, etc. should be reported with the actual date service is rendered in Form Locator 45.

All other form locators must be completed as described in the UB-04 manual. Visit National Uniform Billing Committee’s website at nubc.org*.

Outpatient Medical Emergency form (PDF)

Example — Direct order to admit to observation room
Type of bill (Form Locator 4)
Type of bill “0131” indicates hospital outpatient claim.
Revenue codes (Form Locator 42)
Revenue code "0762" indicates observation room.
HCPCS codes (Form Locator 44)
Required for all observation, laboratory, radiology and drug services. Report G0379, which indicates direct admit. Report total number of observation hours and charges. BCBSM covers up to 48 hours of observation care.
Service units (Form Locator 46)
The number of hours spent in observation is required in the service unit form locator when revenue code "0762" is reported.

When a patient stays in observation up to 48 hours or spans two or more calendar days, report the “from” and “through” dates that reflect the patient’s entire stay. Any observation, laboratory, drug, radiology services, etc. should be reported with the actual date of service rendered in Form Locator 45.

All other form locators must be completed as described in the UB-04 manual. Visit National Uniform Billing Committee’s website at nubc.org*.

Direct Order to Admit to Observation Room (PDF)

For more information about billing, see your health care provider manual on web-DENIS.

*BCBSM does not control this website or endorse its general content.