Wiki Inpatient seen in office

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shyde

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My provider has an office located in a hospital, however he is not a department of that hospital. I am not sure how to code for patients who are inpatients but brought to the office to be seen? I believe the place of service needs to be 21, but as far as what to bill for the visit I do not know. I am new to coding and feel I should know this......but drawing a blank. Any help would be greatly appreciated. Thanks!
 
I've not had much experience with this but I think that there are a few questions that need to be answered before you can get an accurate answer.

1.) Is you doctor on staff at the hospital? do they just have privleges?

2.) Why did the patient come to the OP clinic instead of the doctor go the
the patient to perform a consult?

3.) Just looking for confirmation that the patient was seen in your OP clinic
during the span of the inpatient stay.

4.) Do you have a reimbursement agreement in place with the hospital for
situations such as this where you may not get reimbursed by the
insurance.

If the patient was discharged in order to see you then you would bill it as a normal OP visit with place of service 21. If they were IP and came to your clinic, I think you will have a hard time getting reimbursed for an OP visit when the insurance company sees that the patient was IP at the time you saw them. You may end up trying to seek reimbursement from the hospital. I'll be interested to see what the situation was, and what others have to say about this as well.
 
Thank you for your help and great questions for me to clarify with provider. I know he is not on staff, but does have privileges. I am not sure why the patient was brought to the office as opposed to him going to the patients room? And I will have to make sure documentation is available to let me know if the patient has actually been discharged prior to their office visit.......Thanks again for your help:) I at least have a sense of direction now.
 
In the Medicare manual it states that POS is where the patient is registered. If the patient is a registered inpatient the even thought the service takes place in your office the POS is 21 with regular office visit levels.
 
Debra,

I understand what you're saying, but wouldn't this claim just end up being denied for the place of service not matching the E/M series? if you bill POS 21 you would need to also use inpatient E/M codes, not office visit codes.
 
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No this was explained when the transmittal was released. The POS must match where the payient is registered. The claim will have a field for service location address I think it is field 30 which will be the office not the facility. But you do use the office visit levels.
From the CMS manual:
If the patient is a registered inpatient or an outpatient of a hospital, the correct POS code -- regardless of where the face-to-face service occurs -- is that of the appropriate inpatient POS code (at a minimum POS code 21) or that of the appropriate outpatient hospital POS code (at a minimum POS code 22) as discussed in section 10.5 of this chapter. So, if in the above example, the patient seen in the physician’s office is actually an inpatient of the hospital, POS code 21, for inpatient hospital, is correct. In this example, the POS code reflects a different setting than the address and ZIP code of the practice location (the physician’s office).
 
Very interesting, thanks for the new tidbit of information!

I just did a little searching and found the article below which was publishedby AAPC on 2/1/13. I still think that it could possibly cause a rejection, and this issue is also raised in the article as well, but I had not previously seen the CMS transmittal and am glad that you pointed it out. Thanks again.

http://news.aapc.com/new-pos-rules-get-sticky-for-21-and-22-em-services/
 
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