# observation to inpt



## lfuller (Jul 3, 2008)

Can someone explain to me the documentation requirements if a patient is
admitted to observation, then status changes to inpt the next day, by the
SAME doctor.   Does the doctor have to dictate a new H&P?  An H&P  has
already been done.  Is it appropriate for the dr to reference the observation H&P and
then dictate the next day's findings?  I trying to find the easiest way for them to document.
Thanks.


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## kevbshields (Jul 3, 2008)

My recommendation is to have the provider reference "full H&P", but to also create a record for the patient encounter wherein full admission was decided.  In other words, we really want to see the MDM for why the patient necessitated IP status--this'll help on a number of fronts.

The patient encounters are really separate and distinct from one another; the notes should be too.


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## lfuller (Jul 3, 2008)

So, if on day 2 they say " Mrs B was admitted to observation yesterday, please see my H&P.  Because of worsening XXXXX  I decided to admit her
to inpt status today." and then dr proceeds on.  Is that sufficient to cover
the inpt admit?
Thanks, I really appreciate the input.


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## kevbshields (Jul 7, 2008)

I would advise to perform more than a "bare minimum" if you plan on coding and billing both the Obs admit and the Full Admit.


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## FTessaBartels (Jul 8, 2008)

*Inpatient only*

We do not bill out physician's services for patients in the hospital until the patient has been either 1) discharged; -or- 2) the 7th day of inpatient admission - whichever comes first. This way we're certain of the patient's status (obsv vs inpt), and in most cases we can bill out the entire hospitalization in one session of abstracting the progress notes/ H&P / discharge papers, etc.

In the scenario you describe, where a patient is first admitted to observation and the next day admitted as an inpatient, the hospital does not discharge the patient and re-admit, but changes the patient status for the entire visit to inpatient.  We would therefore bill an Initial Hospital Visit for the first date of admission (even though originally it was for observation), any subsequent hospital visits as documented, and discharge day management as documented. 

Our coders have full access to the hospital charts, so we abstract physician charges. 

Hope this helps.
F Tessa Bartels, CPC-E/M


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## lfuller (Jul 9, 2008)

Well, the situation is a little different, the hsp is leaving pt as obs status on
the first and changing the status to inpt on the second day.  So I can't use
inpt codes the first day,ins denies because of place of service.  It's ok when
the hsp changes the status for the entire stay, but that's not happening here.  It's been something of a problem since the hsp became a critical access hospital.  Does anyone out there have some experience with physician billing  for services that take place in a critical access hosptial?
The way things fall now, I have to bill two intial encounters if the same dr 
does the work, and I'm trying to figure out how to advise them to document
without having to do all the work of 2 separate PEs if they can reference what they've already done.  But I need some clarity here on what's acceptable.
Thank you,everyone.

By the way, I also bill as Tessa Bartels, after the pt has been discharged, so I can bill the whole hsp
stay at once.   The pt status is really as I described above.


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## heycodinglady (Jul 11, 2008)

*Observation to Inpatient*

If the hospital did not change the patient from observation to inpatient status on day 1, what location would we give in locator 32 for the observation status, inpatient or outpatient?


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