# Question to code or not to code?



## daniel (Aug 4, 2010)

Can you code a office visit and Inpatient Consult on the same day with the same patient. (Of Course).

Scenario: The patient comes in the office with a  eKG showing supraventricular tachycardia versus atrial flutter with 2:1 conduction at 150 beats per minute, nonspecific ST-T-wave changes.

So the Cardiologist referrs the patient to the ER to receive IV medication to break up the rythm.

The patient is seen in ER, later admitted by the Hospitalist and then the Hospitalist ask for a Cardio Consult. 

The Consult is done by the Cardioloist that originally seen the patient in his office.

Keep in mind this happend all in the same day.

Can I code out for the office visit and Inpatient Consult.

I know the rule of thumb for the office visit with an Inpatient admitt. It's bundled and on should just code the admitt.

But what about this case.

Medicare states two office visits can't be billed in the same day unless different diagnosis are addressed. 

But there's nothing on a office visit and Inpatient consult being billed on the same day.

Thanks 
Daniel


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## dwaldman (Aug 4, 2010)

B. Initial Hospital Care on Day Following Visit
Contractors pay both visits if a patient is seen in the office on one date and admitted to the hospital on the next date, even if fewer than 24 hours has elapsed between the visit and the admission.

I saw this. But on the same day with different dxs I don't think you will see that to often so usually if they are being admitted I would just bill 9922x


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## dwaldman (Aug 4, 2010)

This might be helpful also

A. Initial Hospital Care From Emergency Room
Contractors pay for an initial hospital care service if a physician sees a patient in the emergency room and decides to admit the person to the hospital. They do not pay for both E/M services. Also, they do not pay for an emergency department visit by the same physician on the same date of service. When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician's office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.
B. Initial Hospital Care on Day Following Visit
Contractors pay both visits if a patient is seen in the office on one date and admitted to the hospital


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## sbicknell (Aug 7, 2010)

This statement is the key "all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission."

His initial office service was not in conjunction with any admit because he did not order the admit. He sent the pt to the ER for treatment and probably was not aware the hospitlist ordered an admit

If your Doc did the office visit and admitted same day, then he gets only the admit service. But your Doc was called for a inpt consult

I would code both the office and the inpt consult (99221-99223 since pt is Mcare). Be prepared to appeal. Make sure documentation is clear on who did what, when and why


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## mitchellde (Aug 7, 2010)

My question is how can this be a consult when your phsycians is already treating the patient for cardiology and the patient was admitted for an exacerbation of the problem your physician sent him to the ER for??  Essentially it is the same dx from what I can see.  I say no to the consult and no to the second visit on the same day, bill it as a subsequent inpatient level and roll the office visit into it for more information.


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## sbicknell (Aug 12, 2010)

I have to disagree.  

The Hospitalist is the admitting/treating physician. He retains control of the patient and can ask a consult from anyone that he needs an opinion on how to care/manage his patient. Since this is a consult requested by the admitting hospitalist, the Cardio gets to keep his office code

If the admitting hospitalist chooses to pass control to the Cardio physician, then the Cardio would code his 1st hospital visit as a 9922x. The Cardio would not be able to keep his office code since this is all same day.


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## mitchellde (Aug 12, 2010)

I would have to see the documentation but it does not look as though this was a consult for the hospitalist, it looks as though he admitted the patient and then called the patient's cardiologist to come and see him.  This is the same problem the cardiologist was treating, it just does not look or feel like a true consult.


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## daniel (Aug 18, 2010)

Great feed back.

I see I'm not the only one confused on this one.

The admitting did request the consult from a Cardiologist per his medical record. Funny thing is that the Cardiologist that so happen to do the consult is the one who asked the patient to go over to the E.R to be stablized without the intention of the patient being admitted or requesting for the admission of the patient.

The cardiologist did document the requirements to meet a consult.

So what I did in this case is, remove the office visit and just submitt the Consult for this day.

Confusing case.

Thanks to all you jump in on this.
Daniel, CPC


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