Wiki Seasoned Coder needs help...

[LOVE2CODE]

I am in need of some help w/documentation.....


Baby was born in hospital, seen by a Peds doctor that is on staff and has a office in hosp.
(We billed this as NEW PATIENT, HOSP CHARGE)

Baby is discharged the next day.

Baby then is seen in the Peds doctor office 7 days later.
(We billed this as ESTABLISHED PATIENT, OV)

However, I need documentation explaining why we have to bill this way and my brain is not working right now (please help w/documentation if you can).

Thanks...

 

[mitchellde]

I am not seeing what the problem is exactly. That is the correct way to bill both encounters.

 

[LOVE2CODE]

I am not seeing what the problem is exactly. That is the correct way to bill both encounters.

I just need to have documentation to give to Physician explaining that this is the correct way to bill both encounters.

Thanks

 

[mitchellde]

Is'nt this self explanatory. I hate to be cryptic but if he has never examined this patient befor it is a new patient and as an inpatient you use the inpatient levels and once the patient has been visited by the provider the patient is established and being in the office setting it is an ov level. What part does the provider need documentation for? If it is the new vs estb part then look up the ruling for new patient, if it is the office visit part then use the CPT book as the setting for each section is well defined. You are not going to find customized documentation you need to use all the coding rules and guidelines. I am just not seeing how your example can be up for question since it is so obvious. What am i missing?

 

[LOVE2CODE]

Is'nt this self explanatory. I hate to be cryptic but if he has never examined this patient befor it is a new patient and as an inpatient you use the inpatient levels and once the patient has been visited by the provider the patient is established and being in the office setting it is an ov level. What part does the provider need documentation for? If it is the new vs estb part then look up the ruling for new patient, if it is the office visit part then use the CPT book as the setting for each section is well defined. You are not going to find customized documentation you need to use all the coding rules and guidelines. I am just not seeing how your example can be up for question since it is so obvious. What am i missing?

LOL (sorry)... You aren't missing anything, I thought I was when he ask for documentation.