Wiki E/M - ER patient admitted to Inpt./Obs

[Scout4413]

This is for clarification--
For patients that are seen first in the ER and then is admitted to In-patient or Obs...
Can we bill for a ER E/M and a In-pt / Obs. E/M on the same date. The E/Ms are done by two different physicians.
Thanks
Pam

 

[btadlock1]

http://medicare-medicaid.com/medicare/the-72-hour-rule-and-medicare-what-you-need-to-know/

 

[mitchellde]

The info referenced above is for facilities only and was update this past July so it is slightly different. If you are billing for a physician, and both physicians are in the same practice then you cannot bill the ER encounter with inpt/obs admit. If they are in two different practices then yes each may bill what he/she did.

 

[OCD_coder]

Good question as a lot of coder's face this very issue.

ER physician's can bill both ER and OBS CPT codes in the ER. Based on the scenario you are presenting and it is still not exactly clear. But it appears you have the ER physician doing his evaluation in the ER, so you would probably follow the 9928X code set or the OBS code set depending on the documentation.

Then the ER physician has contacted the hospitalist to admit to OBS. They are usually two different groups and it would be appropriate to bill an OBS CPT code for the hospitalist on the same day, only if the ER physician billed an ER CPT code.

They may get denied if you bill an OBS for both, as you need a start and stop time for observation documentation. It is unlikely that the ER physician is going to do a discharge time if the patient is then admitted to the Observation floor.

This is a complex situation, so it is a bit grey until all of the documentation can be reviewed.