Wiki Observation to Inpatient

[kimsue63]

Patient is an observation status for 2 days before being admitted to inpatient status; the facility will end up submitting their billing as inpatient. Does the physician bill the first two days as observation, then change to inpatient? Or change all to inpatient? If he bills the first two days as observation won't he not get paid for those since it won't match the hospital billing? This doesn't seem right either way to me.

 

[cynthiabrown]

bill as in pt........pt staus at time of discharge

 

[OCD_coder]

You cannot think like a facility coder when billing for profee services and I assume that is what your scenario is since you are concerned about what the hospital is billing. So billing based on discharge is a facility method and only correct for them.
If the patient status is observation the first two days, you bill the point of service as observation E&M codes, then the last day based on the circumstances. We bill this scenario all the time for our oncologists and internists and we don't have a problem getting them paid and they do not match what the hospital facility bills.

Note: I am told, they way the carrier differentiates is that the type of billing format used, facility is a UB92 and profee is the CMS1500. I have nothing else to back up this.