Wiki 2 E&M same day

[rlcohen76]

Pt was seen in Office and Dr sent pt to ED based on pt's vitals. ED dr admitted the patient. Can our office bill for an E&M as well, providng we meet documentation requirements or no since the patient was admitted the same day?

Many thanks!

 

[RebeccaWoodward*]

Pt was seen in Office and Dr sent pt to ED based on pt's vitals. ED dr admitted the patient. Can our office bill for an E&M as well, providng we meet documentation requirements or no since the patient was admitted the same day?

Many thanks!

Per Medicare Chpt 12:

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.

In other words, if a member of your group (within the same specialty) did not actually admit the patient, your office visit is billable; provided you meet the document requirements (as you already stated). If the provider or a member of your group (within the same specialty) had admitted the patient, the office visit would be "rolled up" into the admission.