Wiki Inpatient surgery 12/30

[Jmyers1205]

Need some help from facility coders! We have a patient who wants to schedule surgery on 12/30 that will be inpatient and their deductible is met for 2024. If we don't discharge them before Jan 1st - will their stay for the 2025 dates be applied to their new calendar year deductible? The insurance is BCBS through the State of Florida employees and we have been getting mixed information from the representatives (of course). I know you can't guarantee anything but just trying to see if anyone knows how this all works. Thank you in advance!

 

[Pam Warren]

It depends. If the payment is made based on fee for service, or a % of charges, then each individual day will be adjudicated based on the DOS. If payment is made based on DRG, the claim will be adjudicated based on discharge date.