# ER Admit to IP/OBS



## pammalou (Feb 13, 2014)

I am preparing for my CEDC exam and am having a hard time getting my head wrapped around an issue, hoping for clarity.  If we have an ER Dr. that sees a patient in the ED and admits them to either IP or OBS with care under another Dr. it has been my understanding that I treat everything as I would any other ER visit.  

If we have a Dr. that follows patients in the hospital setting and happens to be working ER, sees a patient and admits them to IP or OBS is it correct that they do not get to charge an ER level and all their care is lumped into the 99221-99223 Initial Hospital care? And is this if they admit to themselves only or if they admit to anyone??? This is where my confusion has set in and I am very unsure about this one.

Thank you for your help here...I need it


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## jimbo1231 (Feb 17, 2014)

*Who is doing What?*

I'll take a crack at this, but need some clarifcation about the scenario you are dealing with for the exam.

Are you certain the ED doc is admitting the patient in case of hospitalization? That is pretty rare. Typically the ED doc provides the service in the ED, then the patient is admitted by a doc with admission priveleges. So you are right. In that case, for the ED doc's services you would coded for the ED Level, CC, procedures etc based on place of service.

Observation is a bit different. Typically but not always the ED doc is admitting the patient to Observation to a provider in their practice. Here the ED visit would be wrapped into the Observation services coded.

And you are right, if a doc is following a patient or is say a Hospitalist and admits the patient you would typically be coding for Initial hospital Service. And the ED doc would be coded as an ED visit.

jim


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