Wiki Seen in office, sent to ER seen again question

[Jessim929]

Here's a scenario that I'm drawing a blank on what to do.

Patient came into the office (Urology) for scrotal swelling. Doctor examined patient - who was a new patient - and sent him to the ER for an emergent ultrasound to rule out abscess or torsion. He saw the patient in the ER later and ended up doing surgery. Both E&Ms got billed and, weirdly, they got paid. Then BCBS wised up and took back the money on the hospital charge. I know if the patient gets admitted from the office, you essentially build the office visit into the admission code, but what about this situation? Can we bill both? We're querying the doctor to see if he planned to see the patient in the ER or if he was on call and got called in when the ultrasound was read. If it's the latter, we might have a leg to stand on in appeal, but what if it's the former?

Thanks!!!

 

[Linda77]

We have this sort of thing happen all the time but we do not Code/Bill the office visit because the Dr makes it his hospital admit.
Since we code after the fact you can look at the whole scenario. I would say only code/bill the hospital thats what we do. But
even if the Dr. didnt know that that pt would go to the ER the fact is they did.