Wiki ER/H&P double charging??

[katiejeanne]

We have one physician that works our ER and sees patients on the floor on a regular basis. He is dictating one document as the ER/H&P note. Which physician level do we charge for? The E/M code for the ER visit or the charge for the admit? Right now I am billing for the facility and physician side E/M levels for the ER visit and another lady is charging for the physician's admit charge all from the same note. Please help!!

Thanks,
Katie

 

[jimbo1231]

Questionable

Katie,

What you are describing sounds more like a Hospitalist than an ED doc. What I'm hearing is this physician sees the patient in the ER and subsequently admits them. If the H&P had anything to do with the subsequesnt admission the physician should be using an initial hospital code only. Even if the admitting doc had seen the patient earlier in the ED and admitted them later, the ED visit would be factored into the admit visit. If the ED doc separately saw the patient and subsequently this doc came down and admitted the patient than the ED visit would appropriately be coded by the ED physician and your doc would code the initial hospital visit.

Jim

 

[katiejeanne]

Thanks Jim,

This physician is actually one that will work as our ER doctor on call and is also the on call Hospitalist at the same time (we are a fairly small facility). So he does the full ER workup and admission then follows the patient on the floor. I think your response still applies though. I agree with your thoughts, thanks!

Katie

 

[katiejeanne]

Jim, I tried explaining your response to a coworker and I was wondering if you could clarify. Do you mean "initial hospital code" as in the initial service (the ER E/M) or the initial hospitalization code (inpatient E/M). Thank you!!
Katie

 

[jimbo1231]

Initial Hospital Code

Katie,

I'm referring to the Initial Hospital Care CPT 99221-223. It's clearly stated the ED and other codes are rolled into the initial hospital code if both provided by same provider.

jim