Wiki Inpatient Admit

[BonnieJ123]

A new coder starting saying that if the physician has seen the patient recently in office and is now being admitted as inpatient but was seen for the same dx that you should bill a sub-day and not an admit. Also, says due to being an established patient that you should not bill an admit but a sub-day. Have I missed something here. I thought even if they saw them in office the day before and then admitted the next day that we bill an admit.

 

[thomas7331]

I'm not aware of any such guidance. If a patient is seen in the office and admitted the same day, you would bill the admission only, but that rule doesn't apply if they were seen in the office on a different date.

Even if they are familiar with the patient from the office, an admission is a considerable amount of work for a provider because they must perform a full history and exam and create a complete plan of care for the hospital staff to follow. In addition the patient's condition and care needs could easily have changed since the provider last saw them. I don't know what purpose it would serve to down-code an admission to a subsequent visit unless the documentation simply doesn't meet the requirements for an initial inpatient code.

 

[SharonCollachi]

Thomas is right, your coworker is wrong.

 

[BonnieJ123]

Thank you. To take it one step further, the information I am finding documented states the "admitting physician" is the one who bills the IP admit however, do you also agree that if a covering physician for the admitting physician sees the patient and does the work of the admit that the covering physician would bill the admit?

 

[thomas7331]

Thank you. To take it one step further, the information I am finding documented states the "admitting physician" is the one who bills the IP admit however, do you also agree that if a covering physician for the admitting physician sees the patient and does the work of the admit that the covering physician would bill the admit?

A covering physician is by definition one who is assuming the role of the physician for whom they are covering, so yes, if they're doing the work of performing the initial visit for the admission, then they're the one who would bill for it, unless they have some kind of reciprocal billing arrangement in place.