# When OP become admitted to IP.



## stephanie7480 (Mar 31, 2011)

OK forgive me if this is a newbie question but I need clarification about physician billing for a patient who, for example comes to the hospital ER and stays for 2 days in outpatient status then on the 3rd day is admitted to inpatient. When the physician bills (not the facility) would this be:
Day 1 (op)=outpatient initial visit code
Day 2 (op)=outpatient subsequent visit code
Day 3 (ip) = initial inpatient code or subsequent inpatient code ??

Thanks in advance for your help


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## KatrinaKritikos (Mar 31, 2011)

our local hospital turn the whole stay to inpatient. Call your hospital to check their procedure


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## stephanie7480 (Mar 31, 2011)

Let me rephrase my question:



stephanie7480 said:


> OK forgive me if this is a newbie question but I need clarification about physician billing for a patient who, for example comes to the hospital ER and stays for 2 days in outpatient status then on the 3rd day is admitted to inpatient. When the physician bills (not the facility) would this be:
> Day 1 (op)=outpatient initial visit code
> Day 2 (op)=outpatient subsequent visit code
> Day 3 (ip) = initial inpatient code or subsequent inpatient code ??
> ...


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## Mojo (Apr 2, 2011)

If your physician ordered the Observation Status:

Day 1 - Initial Observation Care

Day 2 - Subsequent Observation Care

Day 3 - Initial Hospital Care



Other physicians use office/outpatient codes:

Day 1 - Est/New OV

Day 2 - Est OV

Day 3 - Initial Hospital Care



Supporting documentation can be found in the E/M section of CPT and from CMS.

Highmark Medicare Services offers this training handout:
https://www.highmarkmedicareservices.com/calendar/partb/pdf/ws-observation-required-april11.pdf

Also, the February 2011 Coding Edge has an article on subsequent services of observation coding.


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## stephanie7480 (Apr 3, 2011)

The presentation you provided the link to is awesome and answered my question. This is how I read it in the CPT but I need something from our MAC to present to my manager and the physician to educate them. I raised this issue over a year ago and I was told that I was wrong even though the Medicare Customer service rep told me the same thing. I'm frustrated because we are losing out on lots of revenue as a result. 
Also what issue of Edge Blast are you referring to?


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## Mojo (Apr 3, 2011)

https://www.cms.gov/manuals/downloads/clm104c12.pdf   (30.6.8)  includes observation services.

I didn't see any Obs nifty learning tools on the Palmetto website, only a couple of FAQs.

The article on subsequent day obs services is in the February 2011 Coding Edge, page 16, not the Edge Blast. 

http://aapcperfect.s3.amazonaws.com...5859/968f7981-464b-4cf9-a3c8-401f8c8d873e.pdf


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