OV on inpatient hospital

[mmurdock]

If a patient is inpatient hospital and is transferred by the hospital by ambulance to an office to see a doctor, is there a way to bill an office visit on an inpatient? If this can be billed, how does this get coded? The reason for the transport is because our doctor could not go to that hospital that day and the patient needed to be seen by an ENT.

Any help would be greatly appreciated.

Thanks,

Maureen M

 

[mitchellde]

You can bill the OV level but you use the POS of 21 not 11.

 

[mmurdock]

Thank you Debra!

 

[AdamM123]

I disagree,
If the patient was seen in the providers office the POS is 11 for the office.
21 states the patient was seen in the hospital, which is not the case.

 

[mhstrauss]

I disagree,
If the patient was seen in the providers office the POS is 11 for the office.
21 states the patient was seen in the hospital, which is not the case.

If the patient is registered inpatient on that DOS, you cannot file a claim for POS 11.

 

[mhstrauss]

I disagree,
If the patient was seen in the providers office the POS is 11 for the office.
21 states the patient was seen in the hospital, which is not the case.

See section 10.4 and 10.5 here

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c26.pdf

 

[mitchellde]

I disagree,
If the patient was seen in the providers office the POS is 11 for the office.
21 states the patient was seen in the hospital, which is not the case.

Meagan is correct. You must use the POS for the place where the patient is registered as a patient. The reimbursement will be less than the POS 11 but the payer is already paying for the hospital charge and are not going to also pay an office charge. You can be paid for the visit but at the same rate as if you saw the patient in the facility, hence you are instructed to use the 21 as the POS.

 

[AdamM123]

Thank you for the clarification