# Re-Admit



## Gemini18 (Aug 4, 2009)

I have a record where the patient left the hospital AMA at 2:00pm, patient returned to the hospital and was re-admitted at 3:15pm. It was billed a 99220 - 25. Is this correct?

CC: Shortness of breath
HPI: pt is a pleasant 70-year old female who was admitted intitially on 3/1/09 by Dr. K. for acute renal failure and a. bronchitis. I saw the patient this morning and she left against medical advice, although she was significantly hypoxic, sats as low as 85% w/o oxygen. She refused oxygen and wanted to leave. The patient was brought right back to the ER and they called me to readmit her. The patient is weak all over. she denies chest pain.

No labs were drawn in the ER as they were drawn this morning. 

PMH, SH, FMH

ROS: Health is deteriorating, she just left against medical advice and then did not even leave the hospital and came right back to the ER. The patient is wheezing quite a bit. The patient is short of breath. She is weak, she is hungry now. Denies chest paint. No abdominal pain. All other systems were obtained and found negative, except as mentioned above in my history of presenting illness.

PE: Vitals, skin, lymph, HEENT, chest, heart, abd, ext, neuro, psych.

Labs


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## LLovett (Aug 5, 2009)

What else was billed that day, I see a 25 modifier?

I would be inclined to think you would only get the admit code, if in fact a discharge was billed for the patient leaving AMA, since it covers all services provided that day.

I would probably submit this question to my medicare carrier and get their response, in writing, and go from there.

Sorry not much help here,

Laura, CPC, CEMC


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## Karolina (Aug 6, 2009)

Maybe I am reading this wrong, but it looks like the patient was admitted to the hospital prior to leaving AMA - you said re-admit.

Was a discharge billed already?

Now an observation code is billed, which is outpatient - this is what's throwing me off a bit.

I would think that if the patient was inpatient - the admission occuring on a prior date - in the morning and then returned to go back inpatient, then the whole day would have to be billed as a subsequent daily care.

If she was just admitted in the morning then you would use the admit code and work everything for that day into one code.

Same idea if the patient is in observation status - one code for all services that day.

Finding the right code is depending on the details of your case. Unfortunately there is not enough information given, so the answer is a bit all over the place.

As Laura said, do check with your carrier and see how they would treat this situation.


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## Gemini18 (Aug 7, 2009)

Karolina said:


> Maybe I am reading this wrong, but it looks like the patient was admitted to the hospital prior to leaving AMA - you said re-admit.
> 
> Was a discharge billed already?
> 
> ...



Yes, this is confusing.

I guess because of the wording "RE-ADMIT".  The patient was never admitted on the first visit, she left AMA, she did not want to stay.  Only to return an hour and 15 minutes later.  She came back with the same exact symptoms.

I see it as an admit 99220 (after reviewing the whole chart), I don't know why it was coded with a MOD. 25, there was nothing else done.  

The physician coded a 99232, I guess he's looking at it as a follow-up because the he did see the pt. earlier that day and she returned.  BUT, he NEVER admitted her the first time.

So, my question is -- how do I code this, is the 99220 correct?  

Thanks so much.


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## LLovett (Aug 7, 2009)

What did he code the first time? Subsequent care codes are per day, so you wouldn't have a 99232 in addition to another E/M service, unless it was critical care, regardless of time of day the service was provided.

I think you would probably be correct in coding the obs admit alone for the entire date of service.

Just my opinion, 

Laura, CPC, CEMC


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