Wiki hospital consults and subsequent care days

[Jlokloski]

I have a question about what location code should be used at the time of service. If a patient comes in to the ER and is placed in observation for 24-48 hours and then ends up getting admitted, are we supposed to bill this as an admit even though our doctor sees the patient while he is in observation? Or do we bill this as an admit since that is the final determination? We are being told that even if our doctor sees the patient in observation that once the patient is admitted we are to bill this consult as an admit (21) and not (22).

Thank you for any help.

 

[Dora978]

One you are admitted, you would code for the admit not the outpatient stay. So they are in fact correct. Code using place of service code 21 for the admit. Also that in your CPT book under Initial Hospital Care guideline it is stated that " when the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (hospital, emergency department, observation status in a hospital) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The inpatient care level of service reported by the admitting physician should include the services related to the admission he/she provided in the other sites of service as well as the inpatient setting."

Hope this is helpful

Cornelia

 

[Jlokloski]

Thank you so much. It is very helpful.