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Payment Error Prevention Program (PEPP)The Office of the Inspector General’s (OIG) work plan for FY 2000 includes reviewing one-day hospitalizations and same day admissions and discharges. The OIG estimates that in 1996, approximately $22 million dollars was spent in overpayments in 18 states (New York being one) because of inappropriate one-day hospital stays and same day re-admissions. State peer review organizations (PROs) have been commissioned to review unnecessary and possibly miscoded hospital admissions. The government has named this program the “Payment Error Prevention Program”(PEPP).
This program is geared to review hospital coding of the DRGs assigned for each of these admissions. Currently, the PROs have not been charged with reviewing the physician’s documentation for the professional services associated with the admissions. This may occur in the future. Accurate diagnoses reporting by physicians will assist in establishing the appropriateness of all hospital admissions.
The new same day in-patient admission and discharge procedural codes 99234, 99235, and 99236 where applicable. The observation service codes, 99218, 99219, and 99220, should be considered for use if the patient has been designated as “observation status”, but not admitted to the hospital. Services for a patient requiring observation, but not admission to the hospital, following cardiac catheterization should be submitted with the observation codes. |