Wiki Billing initial inpatient admissions from same specialty

[pedscoder21]

Can you bill an initial inpatient admission code when an attending provider from the same specialty of the admitting provider sees the patient? (Does this vary per insurance carrier?)

Example: Dr. John from urology admits the patient (via order) at 1pm after the resident sees the patient. Dr. John was unable to see the patient, so Dr. Smith from urology sees the patient. Can Dr. Smith bill an initial inpatient admit?

 

[danskangel313]

Can you bill an initial inpatient admission code when an attending provider from the same specialty of the admitting provider sees the patient? (Does this vary per insurance carrier?)

Example: Dr. John from urology admits the patient (via order) at 1pm after the resident sees the patient. Dr. John was unable to see the patient, so Dr. Smith from urology sees the patient. Can Dr. Smith bill an initial inpatient admit?

There's a couple of things going on here. Where was the patient at when he/she was seen by the resident? Keep in mind you have to consider the guidelines regarding resident/supervising physician billing. If a patient is seen by a resident, the supervising physician would need to: participate in some or all of the visit; or, be present during the visit; or, in some circumstances where he/she could not be present during the resident's encounter, then the physician must personally see the patient soon afterwards for an evaluation to determine if the resident's assessment and treatment plan is accurate. Both the resident and the physician must document separate notes and give reference to the other's separate note. The physician's note can't just be "I agree with (the resident's name) plan" or something similar. If the supervising physician doesn't meet the requirements of meeting with patient, that would definitely be cause for concern.

"Only the admitting physician can report the initial inpatient care. According to CPT, the initial hospital care codes, 99221–99223, are for “the first hospital inpatient encounter with the patient by the admitting physician.” Initial inpatient encounters by other physicians should be reported with either subsequent hospital care codes (99231–99233) or initial inpatient consultation codes (99251–99255), as appropriate. Billing an initial hospital visit procedure code is not appropriate if the physician does not see the patient in the hospital."

The patient is considered inpatient as far as the facility goes once the order has been made, but the initial inpt care can't be coded until Dr. John completes his portion of the resident/supervising physician guideline."When a physician is covering for the admitting physician subsequent to admission, you cannot report the service separately." You have the added problem that both physicians are of the same specialty.