HCPCS Code G0378: Hospital Observation Service, Per Hour

Billing with G0378 requires adherence to specific guidelines to ensure accurate reimbursement. Learn more through this guide.

Use Code

## **What is HCPCS code G0378?** HCPCS Code G0378 is defined as the "Hospital observation service, per hour." It is used by healthcare facilities to report hospital outpatient observation services on a UB claim form. This code reflects the hourly observation care services provided to a patient in a hospital setting. G0378 is a facility code, not a physician code, meaning it is used specifically for billing hospital observation services rather than the professional services of physicians. It is often referenced alongside the G0378 code description when reporting care. According to CMS and AAPC information, this code is typically billed per hour of observation. For example, if a patient is observed for three observation hours, the facility would bill G0378 three times. The code is mainly used under the Outpatient Prospective Payment System (OPPS) and has a payment status indicator of "N," indicating that its payment is usually packaged or bundled with other services like emergency department charges, rather than separate payment under Medicare. These observation guidelines are important for medicare contractors who process outpatient claims.

## **HCPCS code G0378 documentation requirements** The documentation requirements for HCPCS code G0378 include: - Observation time and when the patient spends hours under care, aligning with the physician’s order for observation status. This start time triggers when billing using G0378 begins. - Physician orders for observation must be explicit, including clear outpatient hospital admissions and discharge orders. - Patient's condition, clinical findings, treatment, response to treatment, and any changes in condition during observation care. - The physician's concurrence with the hospital's utilization review committee decision to place the patient under hospital observation must also be documented in the medical record. - Periodic notes should reflect ongoing observation care services provided hourly until discharge or inpatient admission. - Observation services are typically billed in hourly increments, rounded to the nearest hour, matching the documented time documented.

## **HCPCS code G0378 billing requirements** Other than documentation, you should be aware of the following billing essentials: - G0378 must be reported on hospital outpatient claims using a Type of Bill (TOB) 13X, 78X, or 85X, with revenue code 0762 for hospital observation services. - The code is billed per hour of observation care provided, rounded to the nearest hour, reflecting the total duration of the significant period the patient is under observation. - Observation services must be patient-specific and reasonable to evaluate the patient's condition or determine the need for inpatient admission. - To be reimbursed, the observation time should generally should meet or exceed 8 hours; services below 8 hours may not be separately reimbursed by Medicare according to Medicare guidelines; however, some Medicare Administrative Contractors (MACs) may exercise discretion to reimburse services provided for less than 8 hours based on clinical circumstances and local coverage policies. - G0378 should be billed only when provided with an emergency department visit, clinic visit, critical care, or referred directly for observation care (G0379) on the same date. - Observation care should be billed on a single claim line with the date of service corresponding to the start of observation, even if spanning multiple calendar days. - The code should not be billed with systemic overlapping hospital care or in scenarios where observation is routine post-significant procedure or routine recovery. These requirements ensure appropriate claims submission reflecting the nature, intensity, and timing of observation services in hospital outpatient settings, and they help directs Medicare contractors in processing claims under the two midnight rule when patients are subsequently admitted.

## **Other relevant codes** - **G0379**: Direct admission of patient for hospital observation care. - **G0463**: Hospital outpatient clinic visit for assessment and management of a patient