# Admitted after Midnight



## becka95 (Dec 23, 2010)

Ok, we have another ongoing argument here about admissions. Based on what I remember, E&M codes are based on where the pt ended up not always where they were seen. So if the patient was seen in the ER as a consult and another Dr admitted you would use the inpatient code for the consult. 

But….. What if the patient was seen in the ER as a trauma at 11pm but the admission orders are not written until after midnight and the H&P isn't dictated until after midnight, what date would you do the admit code? I understand that for some patients it can take a while to stabilize them before they transfer them to the unit. The doctors are arguing that if the patient is admitted in the wee hours, they are losing a day for rounds because the pt is still rounded on later that day. Also, due to the patient's condition, sometimes the doctor may not get a chance to write his notes until after midnight. 

I think that we should bill a prolonged but not all insurances cover the prolonged care. And if the patient doesn't meet Critical Care guidelines, I can't use that.


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## Jagadish (Dec 25, 2010)

If the billing ids are different for ER and your specialty, you can bill a consult on day 1 if the attending physician sees the patient on day 1 and decides to admit the patient. If the admission process happens on day 2 and attending sees the patient and completes the H&P on Day 2, you can bill 99221-3 on day 2. Please provide additional details about the specialties and billing id details for a clear advise.


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## FTessaBartels (Dec 29, 2010)

*Dos*

The date of service is when the physician SEES the patient, not when the paperwork is done.

If the doctor evaluated the patient at 11:00pm on 12-20-10 and determined that admission was warranted, even if that admission (i.e. the hospital bed availability and paperwork) wasn't done until after midnight on 12-21-10, the DOS for the doctor is STILL 12-20-10. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## jdibble (Dec 30, 2010)

FTessaBartels said:


> The date of service is when the physician SEES the patient, not when the paperwork is done.
> 
> If the doctor evaluated the patient at 11:00pm on 12-20-10 and determined that admission was warranted, even if that admission (i.e. the hospital bed availability and paperwork) wasn't done until after midnight on 12-21-10, the DOS for the doctor is STILL 12-20-10.
> 
> ...



We have the same issue at our hospital with date of service vs. date of admission.  As Tessa says, the date that the doctor sees the patient is the date of service, however make sure that your doc documents the actual date of visit in their dictation.  

With out doctors, they may see the patient at 11:00 pm on one day, but when they finally get to dictate their note, the system time and date stamps the note with the time of dictation - which ends up being the next day. When insurance has requested the notes, they have denied the date of service because we billed for the day before but the only date on the note is the dictation time.  We have to keep insisting and reminding our docs to make sure they state in their dictation the date that they saw the patient!



> Originally Posted by Rebecca - "Ok, we have another ongoing argument here about admissions. Based on what I remember, E&M codes are based on where the pt ended up not always where they were seen. So if the patient was seen in the ER as a consult and another Dr admitted you would use the inpatient code for the consult."



As far as if one doc saw the patient in the ER on the night before for a consult and another doctor then admits the patient, I have been told that the doc doing the consult would use a code for where they saw the patient - so in this case it would be either an OP consult or ER visit for a Medicare patient.  I used to think it was how you stated and would code inpatient, but I was advised recently that this was wrong.  If there are other opinions on this I would love to hear them though! 

Thanks,


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## clomija2@gmail.com (Jul 19, 2013)

Could you give me a link for documentation that supports the date of service is the date the doctor sees the patient. Currently the hospital is putting the date of the orders as date of service on H & P and doctor is saying no bill this date because this is the date I seen the patient. Hospital refuses to change the H & P to correct the date even though the doctor is dictating the correct date.


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