Wiki Nurs practitioner sent pt to ER/supervising doc admitted

[lcathey@smsc.org]

WE have a patient that was seen at our Rural Health Clinic by a nurse practitioner who sent the pt to the ER. This was not technically a direct admit. Nurse practitioner is supervised by Dr. M. at rural health clinic. Later that day, ER doc calls Dr. M to admit the pt to the hospital. Naturally Dr. M's charge for the admit is being denied. My question is ... since Dr. M bills with a different tax id for hospital charges and technically he wasn't the treating doc for the OV, do we have a reason to appeal the admit code? We started to just write it off, but feel this really should be considered.
Thanks for any input on this.

 

[jhendrix08]

So we are a PCP office and occasionally see patients that end up being referred directly to the ER after evaluation here; some being admitted that day. We bill a regular E/M code 9921- and then the appropriate Dx code. Our physician will include in his note that he referred patient directly to the ER for further evaluation. Since we don't bill with an admit code, I can't speak to that but I definitely agree that you should be reimbursed for seeing the patient that day. Maybe submit a corrected claim? I hope this is somewhat helpful.