Wiki Office Visit and Hospital Visit

[JCampbell]

I understand that if a patient is seen in the office and admitted to the hospital the work from the office visit would be counted toward the initial hospital visit. If a patient is admitted but then never seen by our provider because they were transferred to a different facility w/in 4 hours of being in the hospital would you only charge the office visit?

I believe the answer is yes but would like other's input.

Thanks,
Jennifer

 

[emcee101]

I'm assuming a couple things from your post so forgive me if I am wrong...

1 - In the first scenario, that both services were performed on the same day . In this case the documentation points for an E/M code could be combined (but not double counted for the same info) to possibly get to a higher level of service. You would bill for the E/M series that would also provide the better reimbursement based on code selection since codes from two series are performed.

2 - in your second scenario, that your doctor is not billing the admission since they never saw the patient. If this is in face the case, all you would have documentation for is the office visit since the patient was never seen in the hospital. Therefore there would be nothing else to bill except for the office visit.

 

[jdibble]

I understand that if a patient is seen in the office and admitted to the hospital the work from the office visit would be counted toward the initial hospital visit. If a patient is admitted but then never seen by our provider because they were transferred to a different facility w/in 4 hours of being in the hospital would you only charge the office visit?

I believe the answer is yes but would like other's input.

Thanks,
Jennifer

Hi Jennifer,

Hopefully I am understanding your scenarios!

If your doctor sees the patient in the office and then admits him to the hospital, then you would only bill for the hosptial admit (99221-99223). If he documents the work from the office into his note, than it can be combined.

In the second half of the question I am not clear on what exactly happened: if your doctor admitted the patient but never saw him before he was transferred, he would still need to document an admit for the hospital and he is still the admitting doctor, but I would bill for the office visit, since he never saw the patient at the hospital.