Wiki e/m for condition resolved

[SandraLynch]

I need a little advice. I have a patient who presented to the hospital for a scheduled procedure, but the condition resolved a few days prior so the procedure was not needed. Can the provider bill an established patient e/m for his time at the hospital?

 

[RGALVEZ]

Did he see the pt and fulfill the requirements for an E&M on the day you want to bill? If not, then NO CHARGE!

 

[FTessaBartels]

Was patient admitted?

Was the patient admitted as an inpatient? OR was the patient presenting for "day-surgery" (observation status, usually)?

If patient was inpatient then you may have an initial H&P.

If this was an outpatient surgery, you may have an established patient visit (POS 22).

Of course, your documentation will determine what level of E/M (if any) you can bill.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[SandraLynch]

Thanks for the help! the patient was presenting for day stay and the provider did meet the requeirements for an E/M. I was leaning towards the established e/m, but just wanted to see what others thought.