Wiki Discharged patient but remains in hospital

[karenpez]

I have a question regarding a patient that is discharged by a physician but remains in the hospital due to pre-certification issues. I work for a hospitalist group and I have seen medical records that state that the patient is ok for discharge to ECF however remains in the hospital due to pre-certification issues. My coding brain tells me that there is no medical necessity for this patient to remain in the hospital, however my physicians are seeing this patient every day until they get the ok to transfer to a ECF and continue to monitor/adjust meds as necessary, review labs, etc. Are these dates of service billable? I have read conflicting info and would appreciate opinions or clarification on this issue. Thanks in advance!

 

[TTcpc]

We do not bill for them here. They are considered "social visits" as it is a clinical requirement that the patient be seen each day by a physician; however it is not medically necessary. Usually in these types of visits, the physician merely walks in does a quick check on the patient to make sure that nothing has come up and if not then we do not bill. There is the rare instance were something does come up and the physician is having to do medical management for the patient.

We do however have a dummy code set up in our EMR billing system to track the number of those types of visits that we do to justify the MDs work volume to the hospital.

 

[karenpez]

thank you, I appreciate the response. I should just listen to my coding brain and not the physicians argument!