# observation to inpt



## lfuller (Sep 25, 2008)

this observation business is a mess.  My question is, if Dr A admits pt to observation on day 1, and the status is changed to inpt, and Dr B (who is in
the same practice-same tax ID) see the pt on day 2, is Dr B's visit an inpt
initial or subsequent visit?  If it is initial, can Dr B reference Dr A's documentation?    Does anyone know how CMS views this? Any references?
Thanks


----------



## FTessaBartels (Sep 25, 2008)

*ROS and PMFSH*

Dr B can reference the ROS and Past Medical, Family and Social History taken by Dr A on the previous day. Everything else Dr B has to document for him/herself.

F Tessa Bartels, CPC, CPC-E/M


----------



## kmaher (Sep 29, 2008)

Great question!! I also deal with this issue with my hospitalists.  I lean toward billing Dr. B's as an IP subday, but I'm open to any suggestions to this as well.


----------



## FTessaBartels (Sep 30, 2008)

*Initial Hospital Visit on first Inpatient day*

When a patient is first admitted to Observation Status and then, on a subsequent day admitted to inpatient status ...
Whichever doctor sees the patient on the day of "admission" to inpatient status can code the Initial Hospital Visit 9922x code. So in your example, Dr B's first visit would be 9922x.

However, some practices follow the guidlines that we use. Our abstractors have full access to the hospital charts. They typically abstract the charts at discharge, or at inpatient day 7 (and then once a week until discharge).

I am talking about *physician* charges, here.  But the hospital in which we practice changes the patient's entire visit status to inpatient once the patient is admitted.  So when the abstractor gets to the chart the "visit status" in the record is inpatient, and we would use an initial hospital visit on the first date of service (even if original intention was to admit for observation).

F Tessa Bartels CPC, CPC-E/M


----------



## kmaher (Sep 30, 2008)

So would Dr. A bill for the admitt 9922x and Dr. B bill for a subday, or would Dr. B bill for the admitt to Ip and Dr. A bill for the admit to obs?


----------

