Wiki outpatient code: same day adm/dis less then 8 hours

Create Wiki
B

b_terickson

Guest
Messages
1
Best answers
0
Just to make sure I am doing this correctly, can someone help? I have a pt. who is an outpatient, in a hospital setting, for less than 8 hours. I have an admit and a discharge. Now I know that I can not bill the sameday admit/ discharge code or the discharge alone. But can i code the admit under Initial observation care code? If I can and it doesnt fit into 99218 - 99220 can I use 99224 - 99226? Thank you for any help you can give me.
 
Use 99234-99236 - But what about 2 MDs?

Hello!
According to the CPT:
"For a patient admitted and discharged from observation or inpatient status on the same date, the services should be reported with codes 99234-99236 [Observation or Inpatient Care Services (Including Admission and Discharge Services)] as appropriate."

Now here's a follow up question:

What should I do since I have one MD who did the admit and one who did the discharge? Should both be able to bill for their services? I am getting a reject when I try to submit the discharge for the second MD.

THE CPT also states:
"For inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99233) as appropriate."

My challenge is that the second MD did the discharge services, not a consultation.

Please advise.

Thank you!
 
kate.charette said:
Hello!
According to the CPT:
"For a patient admitted and discharged from observation or inpatient status on the same date, the services should be reported with codes 99234-99236 [Observation or Inpatient Care Services (Including Admission and Discharge Services)] as appropriate."

Now here's a follow up question:

What should I do since I have one MD who did the admit and one who did the discharge? Should both be able to bill for their services? I am getting a reject when I try to submit the discharge for the second MD.

THE CPT also states:
"For inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99233) as appropriate."

My challenge is that the second MD did the discharge services, not a consultation.

Please advise.

Thank you!
Click to expand...


Are the Admitting/Discharging MD's part of the same specialty/same practice?
 
Actually yes, both MDs are of the same physician group and the same specialty. I hadn't thought of it that way! Thank you!

So should I just bill an observation code (99234-99235) for one? And if so, which MD - the admitting or the discharge? And then how would I show the services of the other?
 
kate.charette said:
Actually yes, both MDs are of the same physician group and the same specialty. I hadn't thought of it that way! Thank you!

So should I just bill an observation code (99234-99235) for one? And if so, which MD - the admitting or the discharge? And then how would I show the services of the other?
Click to expand...


From what I remember reading about this situation (I'll try to find a solid resource for you), since both services were provided by 2 physicians in the same group, it is treated as if the service was performed by just 1, and you can bill the Same Day Admit/Discharge code (99234-99236).

As far as which provider gets credit for it (and whose name goes on the claim), that will be up to your clinic. Maybe set up an internal policy for anytime this happens...for example, always let the admitting MD get the credit, and then track it to see if it comes out fair. Just a suggestion...


Hope that helps!


And I found the article I read this in; check out this link, it has other similar questions too :)

http://www.todayshospitalist.com/index.php?b=articles_read&cnt=727
 
Last edited:
You must log in or register to reply here.
Top