# Patient death in er before bed avlbl for admit.



## nicholelear (May 15, 2012)

HI ALL!
I work for a hospitalist group and one of our doctors turned in charges for an admission 99223. The patient actually expired in the ER before being able to be placed in a room. My understanding is that this charge would be changed to an outpatient consult code. is this correct?

additional info: hospitalist signed admission orders at 11am and left the ER. Patient died @1149 am and pronounced by ER staff. Can I use 99223 if the patient never left the ER? If not can I use an outpatient consult code for this hospitalist?


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## hewitt (May 15, 2012)

CPT Assistant states the following:

"Can a physician bill for a hospital death summary if he or she is not present in the hospital at the time of the patient’s death? If yes, what would be the CPT code(s) to report?  

Answer:  

 The hospital discharge services codes may be used to report discharge services to patients who die during the hospital stay. The attending physician may be needed to perform the final examination of the patient (to pronounce the patient’s death), discuss the hospital stay with family members or others, and prepare the discharge records (such as the discharge summary for the hospital record). However, if the physician is not the discharging physician, there is no CPT code for reviewing the patient’s medical record, selecting and preparing the death summary. The selection of the appropriate hospital discharge services code (99238 or 99239) is based on the unit/floor time, which includes establishing and/or reviewing the patient’s chart, examining the patient, writing notes and communicating with other professionals and the patient’s family. It is important to note, therefore, that there must be unit/floor time, ie, completion of forms/records in the medical records department or completion of a death certificate in the office is not reported as a discharge service."


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## FTessaBartels (May 15, 2012)

*Consult or ER visit*

You cannot code an admission if the patient was never admitted.  Depending upon the payer guidelines you will code the visit as either an outpatient consult or as an emergency room visit.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## nicholelear (May 17, 2012)

Thanks! It helps greatly.


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## masequap (May 17, 2012)

*Different Opinion*

According to CMS guidance you supposed to submit an inpatient claim.  Please read https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/MM4202.pdf for instructions.  

Also read the Medicare Claims Processing Manual Chapter 3 Section 40.2.2 (K) (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c03.pdf) :
K – Inpatient Acute Care Hospital Admission Followed By a Death or Discharge Prior To Room Assignment 

A patient of an acute care hospital is considered an inpatient upon issuance of written doctor's orders to that effect. If a patient either dies or is discharged prior to being assigned and/or occupying a room, a hospital may enter an appropriate room and board charge on the claim. If a patient leaves of their own volition prior to being assigned and/or occupying a room, a hospital may enter an appropriate room and board charge on the claim as well as a patient status code 07 which indicates they left against medical advice. A hospital is not required to enter a room and board charge, but failure to do so may have a minimal impact on future DRG weight calculations.
Most payers follow Medicare rules but check your payers guidelines to be sure.


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