Wiki Discharge/Admit same day/hosp/dx

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linc11

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I'm still not certain I know the answer to this so if anyone has more input I would appreciate it.

Pt is discharged from hospital in the a.m. and then admitted back in the evening by the same doctor with the same diagnosis. I've seen a couple of suggestions out there. One is to append a modifier 25 to one of the visits and the other is to consider this continuous care and bundle both services into a subsequent care code.

Any other suggestions?

Thank you!
 
If it's with the same diagnosis, I would bundle both services into the subsequent care code. If it were a completely different and non-related diagnosis, I would use a modifier 25 to one of the visits.
 
This happens all the time for my Oncology patients. For inpatient coding you have to have two separate CPT codes. Because the admission is looked as as a unit, you ended the first unit with the D/C in the morning. The patient got worse and came back later that day.

It is correct to put a D/C and Admit on the same day - because they are two separate units. You append a modifier 25 on the Admission.

You do not bundle the work together and use one code, the admission would get denied as you can only have one admit code per admission. It would appear to the insurance company that you are trying to bill too high of a code if you don't have that D/C CPT code.

I hope this helps.
 
Have you looked at the observation codes? What does the documentation reflect? Observation codes may apply in this case. Review Inpatient observation guidelines before selecting. Documentation may need legal amendment to support service.
 
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