Observation services involve the use of a bed and periodic monitoring by the facility's nursing or other ancillary staff in order to evaluate and treat an individual's condition or determine the need for possible inpatient admission. Observation services are considered an outpatient service and generally do not exceed 24 hours. These services can be provided in any location within a facility, whether in a specific observation unit, in an emergency department, or on a hospital floor. Observation services should be patient-specific and are not part of the facility's standard operating procedure or protocol for a given diagnosis or service. Observation determinations made by protocol without consideration of the applicability to the specific patient are not clinically appropriate.
There are certain diagnoses and procedures that generally do not support an inpatient admission but may be appropriate for outpatient observation. However, the medical necessity determination for either admission or observation is always made on a case-by-case basis, depending on the severity of illness and intensity of service requirements.