Wiki inpt admit vs er visit

[lfuller]

I would like to know what other practices do about this situation. A pt comes to ER
the evening of 4/21. Is treated,does not improve. On call family provider is brought in
to admit pt. He writes his admission orders at 2335 on 4/21. Dictation of inpt H & P is
completed at 0010 on 4/22. Hospital does not officially admit until 4/22. Pt is Medicare.
I believe the family provider is limited to an outpt code based on POS as his evaluation and
work occured on 4/21. The provider wants to bill an inpt admit on 4/22. What is correct
coding for the family provider in this case?

Thanks
lfuller

 

[OCD_coder]

Per the CPT guidelines, the admitting physician get's credit for the Admit code. It would be 4/22, because that is the official admitting DOS based on the hospital records. The insurance company will deny if the dates of admit and discharge are different than your provider from the hospital's.

If the provider had not admitted the patient, he would have been entitled to the ER CPT code on 4/21, because that is the date he was seen first. It is a tricky situation and a good question.

It takes time to evaluate the patient and get the orders written.