Wiki Billing for Professional fees when patients are admitted but still in the ED

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Barbaraj6

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Hey all,

I have an issues with a carrier telling me that I need to use (E/M) CPT codes based upon the patient's admission statue. For example, if the patient is an inpatient, I should use inpatient E/M codes. While I understand this, I sometimes have situations where the patient is still located in the Emergency Department due to bed availability. I always thought that you have to chose codes based upon the physical location where the face to face services took place. The insurance carrier actually quoted CMS policy that stated codes should be used based upon the patient's admission status regardless as to where the face to face encounter occurred. Does anyone have any insight into this????? Thanks!
 
Inpatient is a status not a physical location. Even if they are waiting for a bed in the ER or hanging out in the observation area it needs to be billed as an inpatient visit. Similar to critical care, one can be in CCU and not be receiving Critical Care service.
 
Yes, agree with the above. My understanding is that the patient becomes inpatient at the time that the physician's order is written to admit them, not at the time that they are moved from the ED to the room.
 
Also agree with above

Everything is order driven. If patient is ordered obs/inpatient, then that's exactly what they are, regardless of location in the hospital.
 
To clarify- If a psy doc see's a patient who is inpatient detox and does 90792, the psy doc bills their code on a hcfa with pos 55?
 
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