Jane Schumacher
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I need advice on when it is appropriate for Internal Med to charge a hospital admit and discharge when a Surgeon is also involved in the patient's care. To put things into perspective, we are a critical access hospital and I oversee the coding for both the hospital and our employed physician professional fees.
Example: Patient is scheduled for an orthopedic surgery. This is a planned surgery, not an emergency. Internal med doc is wondering if he can charge a hospital admit and a hospital discharge code. Let's presume the IM doc did a preop appointment with the patient in his office a week prior to the admission. I'm thinking no, it is not appropriate for IM doc to bill a hospital admit CPT if the reason for admission is the surgery. The surgeon's global would encompass the "admit". I think IM doc should only bill for daily hospital visit codes. Billing of the hospital admit CPT would be driven by medical necessity. If pt's medical situation is stable, there would be no medical necessity demonstrated for IM doc to charge a hospital visit.
But I wasn't sure about the "discharge". I think the global also includes the surgeon's activity for "discharging" the patient. But I was not sure about the IM doc. Sometimes on a patient with a more complex medical history/chronic conditions that are being managed, the surgeon will write "okay to discharge if okay with Dr. X" if the patient is a bit more complex medically. In that instance, could the IM doc charge a discharge code rather than just a hospital visit code?
Second scenario: Let's say IM doc sees patient the office; patient complaining of severe abdominal pain. IM doc admits and requests consult by Surgeon, who subsequently performs surgery. I say this situation demonstrates medical necessity and IM doc could bill the hospital admit CPT.
Appreciate your input and any "official" guidance you can point me to (CMS, etc). We have an IM doc who went to a "coding class" he says, which I think was geared toward hospitalists, and now he has all kinds of ideas for how he should be charging for his services.
Example: Patient is scheduled for an orthopedic surgery. This is a planned surgery, not an emergency. Internal med doc is wondering if he can charge a hospital admit and a hospital discharge code. Let's presume the IM doc did a preop appointment with the patient in his office a week prior to the admission. I'm thinking no, it is not appropriate for IM doc to bill a hospital admit CPT if the reason for admission is the surgery. The surgeon's global would encompass the "admit". I think IM doc should only bill for daily hospital visit codes. Billing of the hospital admit CPT would be driven by medical necessity. If pt's medical situation is stable, there would be no medical necessity demonstrated for IM doc to charge a hospital visit.
But I wasn't sure about the "discharge". I think the global also includes the surgeon's activity for "discharging" the patient. But I was not sure about the IM doc. Sometimes on a patient with a more complex medical history/chronic conditions that are being managed, the surgeon will write "okay to discharge if okay with Dr. X" if the patient is a bit more complex medically. In that instance, could the IM doc charge a discharge code rather than just a hospital visit code?
Second scenario: Let's say IM doc sees patient the office; patient complaining of severe abdominal pain. IM doc admits and requests consult by Surgeon, who subsequently performs surgery. I say this situation demonstrates medical necessity and IM doc could bill the hospital admit CPT.
Appreciate your input and any "official" guidance you can point me to (CMS, etc). We have an IM doc who went to a "coding class" he says, which I think was geared toward hospitalists, and now he has all kinds of ideas for how he should be charging for his services.