Wiki 2023 OFFICE VISIT WITH ADMIT

Create Wiki
A

aarms

Contributor
Messages
10
Location
Tompkinsville, KY
Best answers
0
I just received the 2023 CPT E&M guidelines and since the wording has changed I am needing to clarify something. For example: A patient sees provider at the office and is admitted to the hospital, but the provider does his rounds the NEXT morning (which is the first time seeing the PT in the hospital).
So is the office visit considered the "Initial" and the next day at the hospital visit considered the "Subsequent" OR is the 1st day seen in the hospital considered the "Initial" for 2023?
 
AmandaBriggs said:
Is the provider using the office visit as the H&P?
Click to expand...
Yes he will bill the office visit. (I didnt think I could bill a hospital "initial" in place of the office visit E&M since he didn't actually see the patient at the hospital the day of admit)
I should also add that the provider I work for has a group owned by the same hospital that he admitted the patient to. So the office visit and any professional hospital charges are billed under the same tax id# if that makes a difference.
 
Your provider would have to have a face-to-face encounter with the patient in the hospital to bill the H&P. Does the provider's documentation on the second day meet all of the criteria to bill an H&P (3 of 3) or does it only support a subsequent hospital visit (2 of 3)?
 
AmandaBriggs said:
Your provider would have to have a face-to-face encounter with the patient in the hospital to bill the H&P. Does the provider's documentation on the second day meet all of the criteria to bill an H&P (3 of 3) or does it only support a subsequent hospital visit (2 of 3)?
Click to expand...
Ok that’s what I thought but kept finding mixed answers on other threads. As for the notes meeting the new MDM level guidelines for 2023 I will have to read more on the changes. From what I have read so far you wouldn’t choose a subsequent if it’s an initial, you would just choose the level of initial based on the overall MDM right?
 
Here's my summary:
Bill initial if it's the first visit, even if it's not the first day. This did not change 2023 vs prior TO MY KNOWLEDGE SO FAR. I am not aware of the definition of initial vs subsequent changing.
What has historically been an issue is for patients with multiple providers (like consultants) involved in the care, and this may have been what you were reading on other threads.
Medicare explicitly states all providers treating the patient may use initial inpatient codes. The admitting provider adds -AI.
Many commercial carriers follow this guideline, but some have their own policy to only pay the admitting for initial and all others should bill as subsequent.
 
You must log in or register to reply here.
Top