# Admit date after midnight



## tfischer (Dec 31, 2009)

I do coding for a hospitalist group and I have a question that has been a problem for quite awhile. A patient comes into the hospital late at night on DOS 12/28/2009. By the time one of our hospitalist gets to see the patient it is after midnight on DOS 12/29/2009. We need to know what date we are supposed to be actually charging as the admission?

Also, if another physician outside of our group does an admission (H&P), and the hospitalist gets called back on the same DOS to see the patient for a different reason, are we able to bill a progress note? 

Thank you! HAPPY NEW YEAR!


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## JenniferVC (Dec 31, 2009)

I have had this same problem with my group of Physicians so I spoke with CMS to see what they would say. I also have it in writing from them. Also, BCBS and others follow the same admission process, which I have documentation from them stating this. This is the rule...

You charge the Initial Hospital Visit the date the physician was physically at the place of service(hospital) seeing the patient. It does not matter if the patient was admitted the day before, you only charge for that initial visit the day the physician was actually there. This is also listed in the CMS internet only manual. If you want, you can email me and I can fax you what I have from them and my own documentation I have found.I can also give you the section of the internet only manual to find this in. I am at home right now and do not have this information here. I hope this helps.

jcunningham@bromenn.org

Jennifer C., CPC, CIMC


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## hsmith67 (Jan 2, 2010)

*More info*

Tiffany,

I agree with what Jennifer said. Another way to think about it is a patient waiting in the ER (that subsequently gets admitted after being seen/admitted) has not officially been admitted. If the patient is seen after midnight and the decision to admit is made after midnight, then the "admission" is done on that date (after midnight). 

Regarding your question on another group sees the patient and then the hospitalist is called back to see the patient for a different reason - there can only be one progress note per day (read--consults are a different issue, not included in this situation) unless the hospitalist is being called in for critical care. 

If the hospitalist is the only person to see the patient, sees the patient 3 times at 15 minutes each on one DOS, then the hospitalist should ensure he/she bills the appropriate code for 45 minutes (vs. the 1 15 minute and other two at no charge). 

Hope this helps,
Hunter Smith, CPC


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## tfischer (Jan 4, 2010)

*Same date of service being charged*

Hunter,

There would not be two progress notes charged on the same date of service. The physician NOT in our group is doing the admission (99221-99223). We (the hospitalist) are being called back to do a progress note (99231-99233). In this case, would we be able to charge as long as we are not using the same diagnosis?

Thank you both for your help on the first question...


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## mitchellde (Jan 4, 2010)

hsmith67 said:


> Tiffany,
> 
> I agree with what Jennifer said. Another way to think about it is a patient waiting in the ER (that subsequently gets admitted after being seen/admitted) has not officially been admitted. If the patient is seen after midnight and the decision to admit is made after midnight, then the "admission" is done on that date (after midnight).
> 
> ...



Visit levels cannot be billed based solely on time.  If your physician sees the patient 3 times on the the same day you combine the assessments from all three encounters and level the visit based on the information in all three.  Not based on time alone.


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