Wiki Coding Observation/Inpatient from end of Dec -Jan 2023

[mlrussell]

If a patient is admitted to Observation 12/30/22 and isn't discharged until 1/2/23, because of the new Inpatient coding rules for 2023, do I code Obs codes for Dec and inpatient for Jan? Like I would have to send two different claims?
Thanks in advance!

 

[thomas7331]

Are you talking about a facility claim? If so, in my experience most payers process the entire claim based on the rules in place on the date of admission. However, some payer may request that you split the claim into two (bill types 112 and 114) if they're not able to process the span across two calendar years. This might happen if there is a change in patient eligibility beginning with the new year, for example.

 

[mlrussell]

Are you talking about a facility claim? If so, in my experience most payers process the entire claim based on the rules in place on the date of admission. However, some payer may request that you split the claim into two (bill types 112 and 114) if they're not able to process the span across two calendar years. This might happen if there is a change in patient eligibility beginning with the new year, for example.

I am talking about the professional claim. But yes, sometimes people switch insurances the first of the year and it would be similar to that.

 

[thomas7331]

I am talking about the professional claim. But yes, sometimes people switch insurances the first of the year and it would be similar to that.

If you're coding professional, then you'll code according to the rules for each date of service. You shouldn't need to send separate claims to do this - it's just you'll code the lines with the 2022 dates one way and the 2023 a different way.