# Admit code?



## cdcpc (Apr 1, 2009)

I've thought this through and I'd like confirmation before advising my physician.  
My question is: in this scenario, is it appropriate to charge 99223?  
Dr. A sees a patient in the ICU and performs an H/P.  This patient presented to the ER unable to move arms and legs and Dr. A assumes he will be admitting the patient.  However, due to the patient's condition, the patient was later transferred to a different hospital.  Here is part of Dr. A's dictation:
_" PLAN: I called on neurologist, Dr. B, and reviewed this case. He feels that given his age and the new onset that he should be transferred to a tertiary care hospital. I have placed a call to the doctors access line and I am waiting for their response. In the interim I am going to begin a workup for the fever including blood cultures, urine culture, a chest x-ray, and I am going to start broad spectrum antibiotics. I am also going to request an MRI of the head and the cervical spine although if he is transferred before the tests are completed, then I will defer that to the receiving institution."_
Dr. A clearly started the visit meaning to admit the patient.  Once he determined the patient needed to be transferred, he still ordered tests in case there was time to complete them before the patient was transferred. The rest of the documentation had a comprehensive history, comprehensive exam and a high complexity medical decision making.  
I've looked at other codes and none seem to fit the scenario as well as the admit codes, but I wanted to see what others thought.
Thanks a bunch!!


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## 007CPC (Apr 1, 2009)

cdcpc said:


> I've thought this through and I'd like confirmation before advising my physician.
> My question is: in this scenario, is it appropriate to charge 99223?
> Dr. A sees a patient in the ICU and performs an H/P.  This patient presented to the ER unable to move arms and legs and Dr. A assumes he will be admitting the patient.  However, due to the patient's condition, the patient was later transferred to a different hospital.  Here is part of Dr. A's dictation:
> _" PLAN: I called on neurologist, Dr. B, and reviewed this case. He feels that given his age and the new onset that he should be transferred to a tertiary care hospital. I have placed a call to the doctors access line and I am waiting for their response. In the interim I am going to begin a workup for the fever including blood cultures, urine culture, a chest x-ray, and I am going to start broad spectrum antibiotics. I am also going to request an MRI of the head and the cervical spine although if he is transferred before the tests are completed, then I will defer that to the receiving institution."_
> ...




What Guidelines are you using 1995 or 1997.Also, I was instructed by my coding instructor you only code Dx and Px for the facility your doctor sees the patient. If he started test at facility A and test were completed at a facility B, you should only code Dx and Px at facility A. Once interfacility transport has been started that is a whole other coding system


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## LLovett (Apr 1, 2009)

Did he then discharge the patient on the same day to go to the other facility? If so what about 99236.



Just my thoughts,

Laura, CPC


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## FTessaBartels (Apr 1, 2009)

*99291?*

You say the physician saw the patient in the ICU.
Okay, at our hospital you can't be in the ICU unless you are an inpatient.

So you either have an admit & discharge on the same date
*Or* ... 
You have critical care (if the patient was critically ill and 30 minutes or more critical care was provided) + discharge. 

Hope that helps

F Tessa Bartels, CPC, CEMC


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## cdcpc (Apr 2, 2009)

*Thanks*

I'm using the 1995 guidelines.  My physician only dictated an admit note and nothing was documented for a  discharge, so I wouldn't feel comfortable using the same day admit/discharge codes.  
Thanks for the responses everyone.


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## FTessaBartels (Apr 2, 2009)

*Don't get hung up on the title of the note*

Carrie, 
Don't get hung upon the title of the documentation. I've seen "ER Consults" (as they are titled, and filed in the record) that are really Initial hospital visits. I've seen "H&P" that are really office visits. (The provider doesn't want to dictate twice ... seen in office today, will be admitted tomorrow for day surgery... I know, don't get me started...)

If I'm reading and interpreting the body of the documentation accurately, the physician is clearly making plans to discharge and transfer the patient to another facility. So I'd give credit for the admit/discharge on the same day. 

Just my opinion,

F Tessa Bartels, CPC, CEMC


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## cdcpc (Apr 2, 2009)

F Tessa,
LOL!  I've run into the same scenarios!  Now that I'm reading it again, your perspective is really making sense now. Thanks


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