# Documented "Admission" Done on Day After Hospital-Billed Admission



## Belinda Frisch

Our business office is apparently experiencing denials for admissions based on date of service (and what I assume is claims matching).

Here's the scenario:

A patient comes to our hospital in the late afternoon/evening and is "admitted" as an inpatient. The actual admission H&P (physician documentation) is done the next day when a hospitalist is on-staff. The hospital bill is surely going in with the first day as the admission day, though our physicians have a 24-hour window to do the actual admission examination.

Our director mentioned changing the date of service, but I say it won't match if the documentation is for the subsequent day and I'm not aware of any Medicare regulation that states you can change admission dates. The only exception I'm aware of for date of service is when a patient is pronounced dead and the death certificate is completed on a later date--Medicare allows you to bill the actual date of death as the date of service in that instance.

Anyone have any thoughts on this? Are we the only ones having this problem?
PLEASE provide resources when possible.


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## FTessaBartels

*We appeal the denials w/ documentation*

We bill the date of service on the date it was provided ... in your example, hospital day 2. If we get a denial, we appeal w/ documentation. 

This happens in reverse for us, too ... patient arrives in the ER at 23.30. Doctor does all the admission work-up and admits, but the hospital doesn't get the patient officially admitted until the after midnight. Our 99221-23 service is still billed out as the date the physician saw the patient. 

Good luck!

F Tessa Bartels, CPC, CPC-E/M


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## Belinda Frisch

*Thanks*

That was my position, too. Thanks for the confirmation.


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## fredabrinson

*Admission orders*

When are the admission orders executed by the hospital?  If the patient is receiving hosiptal services today but the admitting physician does not come to the hospital to physically see the patient until tomorrow, why should the hospital miss a day of charges?

I am not a biller so I do not know the details or what might be required, but from a compliance standpoint, I would be looking for the date of admission to match the date the hospital services were rendered, but not necessairly the date the physician documents his physical exam.  I would expect the admitting orders to match the hospital admission date with the hospital documentation of those services.

I could very well have misunderstood the previous answer, but it sounded like the hospital was ignoring the date of the physical admission of the patient, and was going by the date the physician physically saw the patient.


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## geigerk

Make sure you read the CPT book code for "admission".  The code is actually called the initial hospital visit.  You always file this on the actual calendar day of your provider's service.  E/M codes are calendar day driven.  (physician billing)

The only exception is in a teaching hospital facility, the teaching physician has 24 hours to attest to the resident's admission note.  As long as the resident documents the admission and the TP properly attests w/in 24 hours, you can bill on date of admission. 

Hospital CoPs also give you time to get the H & P in the records - but hospitals should have the admit date as the actual admit date.  Should be documented procedure on what determines the admit date - probably physician order time or transfer time??  Hope this helps!


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## heatherwinters

*Similar Question 99231-99233*

I am just starting hospital billing for our doctor here.  I am running into the same scenario, my doctor is the admitting doctor and his initial H&P is done on the following day as the admission, when this is the case, I would charge the 99231-99233 on the actual calendar date he actually saw the patient, correct.


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## FTessaBartels

*DOS is the actual date service provided*

Heather,
You use the phrase "initial H&P is done" ... 

If you mean that the physician doesn't see the patient until the next calendar day, then yes, you are correct that you would use a date of service of the actual date the patient was seen. e.g. Patient admitted 01-07-09; doctor sees patient for initial hospital visit 01-08-09. You would have a DOS of 01-08-09 for the 9922x service.

If you mean when the physician does the dictation/paperwork ... then you need to know what date the patient was actually seen. The date of service for your bill is the date the service was rendered, i.e. the date the patient was seen & examined. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## SCanterbury

Kelly, 

Where is this allowed by Medicare?:

"The only exception is in a teaching hospital facility, the teaching physician has 24 hours to attest to the resident's admission note. As long as the resident documents the admission and the TP properly attests w/in 24 hours, you can bill on date of admission."

Seth Canterbury, CPC, ACS-EM


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## jas0426

I'd like to know to, if that is the case we are missing out on an extra day....


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