# Code this scenario please:



## Partha (Jul 20, 2009)

*Here's the scenario: patient came in ER was treated by ER staff and put in observation, they decide to discharge patient with in 23 hours, House docs come in and do patient's discharge, patient leaves without being ever admitted as inpatient.

Thanks!!!*


----------



## LLovett (Jul 20, 2009)

Based on what you are saying the ER doc would bill the admit to obs and then the house doc would only get an outpatient E/M, either new or established. Nobody gets the discharge, since only the admitting provider can bill for a discharge.

Laura, CPC


----------



## Partha (Jul 21, 2009)

*So the house doc can bill outpatient E/M*


----------



## LTibbetts (Jul 22, 2009)

It depends. Was the house doc just doing the discharge or was it a consult? I don't think that the house doc can charge at all unless it was a consult. When a pt is admitted and discharged as an OBS pt within a 24-hour period, there should only be one OBS code used, unless it was a different DOS entirely. I am extremely confused by OBS codes (even though I do them here at my hospital) so please, correct me if you think I am wrong....


----------



## LLovett (Jul 22, 2009)

I see no reason the house doctor would not be able to bill an outpatient E/M.

http://www.cms.hhs.gov/Transmittals/Downloads/R1466CP.pdf

This policy talks about the admit and discharge and what that physician can charge if the obs goes over 2 days. My understanding based on cms is that only the admitting provider can bill for a discharge. Everyone else gets consults, subsequent days, or in this case outpatient E/M. If this is incorrect I hope someone will please post a link to the information showing otherwise and I will take that to our medicare carrier and ask for clarification.

I don't personally agree with only allowing the admitting provider to do the discharge. There are many times my providers take over care on someone elses patient, but we didn't admit so we only get subsequent days.

Laura, CPC


----------



## LTibbetts (Jul 22, 2009)

But was her example for a patient that was there over 2 days?

confused.....


----------



## FTessaBartels (Jul 23, 2009)

*House doc*

Based on how you worded the scenario it seems that the ER did the admission AND made the decision for discharge ...  so I agree that *in this case *the house doc codes an outpatient visit (either new or established depending on whether the practice/specialty has seen the patient in the last 3 years).

However ... if the ER doc said "this patient needs observation" and the house doc (who is the *official* "admitting" physician)  didn't get there to do the initial visit until it was time to discharge ... then the ER doc bills for ER services and the house doc codes the 99234-99236 (admit & discharge on same DOS). 

At our hospital the ER doc NEVER codes an admission (either inpatient or observation). 

Hope that helps.

F Tessa Bartels, CPC, CEMC


----------

