# isn't this "double dipping?"



## efuhrmann (Aug 10, 2012)

Provider sees a patient and bills the appropriate e/m code.  This same patient is admitted within 30 days and when I look for documentation of the admit code(same doctor), I find the office visit note, only stamped with "no interval changes in physical condition" and signed by the provider.  I am being told this is legal and appropriate to bill both using the same note.  If indeed, this is true please cite a reference cuz it doesn't seem correct.  Thanks.


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## awebb0428 (Aug 10, 2012)

The provider has already been paid for the elements of that note by the OV billed orignially so thoses elements cannot be counted for the admit later.


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## btadlock1 (Aug 10, 2012)

efuhrmann said:


> Provider sees a patient and bills the appropriate e/m code.  This same patient is admitted within 30 days and when I look for documentation of the admit code(same doctor), I find the office visit note, only stamped with "no interval changes in physical condition" and signed by the provider.  I am being told this is legal and appropriate to bill both using the same note.  If indeed, this is true please cite a reference cuz it doesn't seem correct.  Thanks.



Show them the required components for 99221-99223 - You can't use interval history for initial inpatient codes - the key component requires either a detailed or comprehensive history. Interval histories are included on subsequent inpatient codes only. 

Plus, if the patient's condition hadn't changed since the last time he saw them, then why did he suddenly feel the need to admit them? Obviously _something_ happened between then and now.
He needs to take the extra 5 minutes and document an updated history, or he'll risk looking like he's admitting patients to the hospital without any medical necessity. Hope that helps!


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## mcnaryk (Aug 10, 2012)

efuhrmann said:


> Provider sees a patient and bills the appropriate e/m code.  This same patient is admitted within 30 days and when I look for documentation of the admit code(same doctor), I find the office visit note, only stamped with "no interval changes in physical condition" and signed by the provider.  I am being told this is legal and appropriate to bill both using the same note.  If indeed, this is true please cite a reference cuz it doesn't seem correct.  Thanks.



No that is not correct. A thorough exam and proper documentation must be done to support the admit claim. Even if for the same reason, the workup needs to be completed and not just copied from the previous visit. That's just unethical and lazy.


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## efuhrmann (Aug 10, 2012)

thanks and I agree with all of you, however if someone could cite a reference I would be golden.  I am reviewing the CPT book now and reviewing the initial hospital care rules.


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## btadlock1 (Aug 10, 2012)

efuhrmann said:


> thanks and I agree with all of you, however if someone could cite a reference I would be golden.  I am reviewing the CPT book now and reviewing the initial hospital care rules.



Your CPT book - seriously. Read the code descriptions for 99221-99223, then look at 99231-99233. You'll only see the word "Interval" on subsequent code requirements. Let me know what payer & state are involved, and I'll give you a mountain of supporting documentation. This is an easy one.


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## efuhrmann (Aug 10, 2012)

One is for Humana.  On 4/24 he billed a 99245 then billed 99236 on 5/17/12.  The 4/24/12 consult is stamped with no interval changes in physical condition and filed as documentation of the admit/discharge same day.


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