# Resolved diagnosis and inpatient visits



## Love Coding! (May 10, 2011)

Hello,

Can anyone direct me to where I can find the answer to this question. Can a physician bill for a resolved diagnosis in the inpatient hospital setting? Example: The patient had hyperkalemia on the initial hospital visit and shows up as "resolved" on the third subsequent hospital visit and the physician billed for hyperkalemia, even though it's resolved...

We have Noridian Medicare and we also work with Palmetto (Nevada) Medicare.

Any help will be greatly appreciated..

Thank you!


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## jdibble (May 18, 2011)

021402 said:


> Hello,
> 
> Can anyone direct me to where I can find the answer to this question. Can a physician bill for a resolved diagnosis in the inpatient hospital setting? Example: The patient had hyperkalemia on the initial hospital visit and shows up as "resolved" on the third subsequent hospital visit and the physician billed for hyperkalemia, even though it's resolved...
> 
> ...



It would be helpful if the scrubbed note was posted to see what you are referring to.
What do you mean by the physciain "billed" for hyperkalemia?  Is that the only dx the patient had?  If he was billing a subsequent hospital visit, the "resolved" dx of hyperkalemia would figure into his MDM for the E/M level - established problem, stable or improved for 1 point. This would be added up with any other dx he is treating to come up with the number of diagnoses/treatment options. If this is all the patient was in the hospital for, then I would assume he would be discharged. 

Thanks,


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## Love Coding! (May 18, 2011)

jdibble said:


> It would be helpful if the scrubbed note was posted to see what you are referring to.
> What do you mean by the physciain "billed" for hyperkalemia?  Is that the only dx the patient had?  If he was billing a subsequent hospital visit, the "resolved" dx of hyperkalemia would figure into his MDM for the E/M level - established problem, stable or improved for 1 point. This would be added up with any other dx he is treating to come up with the number of diagnoses/treatment options. If this is all the patient was in the hospital for, then I would assume he would be discharged.
> 
> Thanks,



Thank you Jodi for responding, let me explain further...

I guess all I need to know is , can a physician bill for a resolved diagnoisis in the inpatient setting?  Yes or no?  I know that you can bill for a rule out, probable diagnosis, but resolved?

Thank you,


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## mitchellde (May 18, 2011)

021402 said:


> Thank you Jodi for responding, let me explain further...
> 
> I guess all I need to know is , can a physician bill for a resolved diagnoisis in the inpatient setting?  Yes or no?  I know that you can bill for a rule out, probable diagnosis, but resolved?
> 
> Thank you,



A physician cannot bill for rule out or probable in the inpatient setting, only the inpatient facility can do that.  The provider must code code based on the information in each encounter.  There fore if a condition has in fact resolved then no the provider cannot code it as though it were still current for that encounter.  The exception is infections, infections are coded as thought they exist until after the encounter where it has been deemed resolved.  In other words physician rules apply no matter the place of service.


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