# Can U Bill A Subsequent after Discharge?



## Gainingknowledgedaily (Jun 18, 2009)

Hi and Good Afternoon to all of you!! 

    I have a tough question for you, can you bill a subsequent visit after the day the discharge summary was billed out?'
So for example, Dr. Z came in and did a discharge summary on 5-17 well then a different provider who was providing concurrent care or for that matter maybe even someone from Dr. Z group comes in and sees the patient the next day 5-18. Can that provider then bill a subsequent? I cannot find this anywhere in CMS or anywhere else for that matter. 
PLEASE HELP!!!
I hope I explained my question thoroughly. Sorry if I didn't
Please provider resource if possible.


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## LLovett (Jun 18, 2009)

Why didn't the patient leave after the discharge was done?

Laura, CPC


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## Karolina (Jun 18, 2009)

This is a peculiar situation. If I understand correctly, the patient was discharged by Dr. Z - papers were filled out, instructions given, f/u appointments booked as appropriate.... and then the patient stayed in the hospital? Or did he leave and got sick again and come back?


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## Karolina (Jun 18, 2009)

Here is a link to cms:
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
Look at 30.6.9.2 (B and C). This does not really address your question, but it may give you something to get started with. 
If the second provider (the 5/18 visit) provides concurrent care not related to Dr. Z's care he would bill daily care on the discharge day. The discharge can be done on a day that is not the actual day the patient leaves so one might interpret it that Dr. Z does all the discharge work on the day prior to discharge but is pretty much done caring for this patient for now, e.g. "pt to go home tomorrow...". Next day the patient is still in house and the concurrent provider, perhaps a cardiologist, checks the pt. one more time and should be able to bill. 
I recommend to check with your local carrier to see if they have anything more specific in place or how they would deal with the situation. This is certainly the exception (I would think).


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## Gainingknowledgedaily (Jun 18, 2009)

TO reply, this does happen on occasion, when I have asked the response was that the provider decides to the d/c knowing the patient will be d/c in morning but since the Dr. know the patient hx, plan, etc, he decides to do the d/c so the new provider that is coming on does not have to, because that provider will not be as familiar with the patient. 
 I did read in CMS that "The E/M discharge day management visit shall be reported for the date of the actual visit by the physician or qualified nonphysician practitioner even if the patient is discharged from the facility on a different calendar date."http://www.cms.hhs.gov/transmittals/downloads/R1460CP.pdf
But I just could not find if it would be appropiate to bill a subsequent after that. 
Thank you everyone for your help and replying so quickly. I appreciate it very much and if anyone has any more info or resource for me; please post. 
Thank you again, everyone.


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## Karolina (Jun 18, 2009)

From what you say I suppose the new doc is someone taking over the patients for the other one, e.g., changing rotations? In that case my guess is that he cannot bill since the pt was discharged by the other doc from the same service. But check with your local carrier to make sure.


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