# observation to inpatient same day



## stephmescher (Jun 28, 2018)

Hello,
Wondering if a new H&P needs to be done when a patient goes from observation to inpatient same day or is reference made in inpatient note ok?
Thanks
Steph Mescher


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## TTcpc (Jul 2, 2018)

stephmescher said:


> Hello,
> Wondering if a new H&P needs to be done when a patient goes from observation to inpatient same day or is reference made in inpatient note ok?
> Thanks
> Steph Mescher



Is it the same physician/group that ordered obs ordering inpatient?  The reason I am asking is that according to CMS below, the only charge that day would be the inpatient charge, so no additional note would be needed other than the medical necessity regarding the change in status.  Our providers do the one note and if they or UR decide that the status should be changed then that provider writes the order to change to inpatient status and charges the initial inpatient charge - the order in our EMR has an area where the provider has to document the medical reason.  Be careful though of backdated orders as this is not allowed.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2282CP.pdf

D.  Admission to Inpatient Status Following Observation Care 

If the same physician who ordered hospital outpatient observation services also admits the patient to inpatient status before the end of the date on which the patient began receiving hospital outpatient observation services, pay only an initial hospital visit for the evaluation and management services provided on that date.  Medicare payment for the initial hospital visit includes all services provided to the patient on the date of admission by that physician, regardless of the site of service.  The physician may not bill an initial or subsequent observation care code for services on the date that he or she admits the patient to inpatient status.  If the patient is admitted to inpatient status from hospital outpatient observation care subsequent to the date of initiation of observation services, the physician must bill an initial hospital visit for the services provided on that date.  The physician may not bill the hospital observation discharge management code (code 99217) or an outpatient/office visit for the care provided while the patient received hospital outpatient observation services on the date of admission to inpatient status.


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