Wiki Admit & transfer coding help

[mraymond74]

One of our doctors saw a patient in the hospital. However she was not our patient. We did not admit patient. Our doctor said that her doctor could not get there in time and patient was needing care.
Our doctor stated that she saw patient for 2 hours intensive management & than transfered her to another hospital. This patient is 25 weeks pregnant with incomplete cervix, pain & discharge, & active herpes.
Doctor wants her time to be reimbursed and stated that we could use critical care services 99291 & 99292. Does anyone have any ideas on coding a senerio like this?

 

[LTibbetts]

Be very careful reporting critical care codes and make sure that it is clearly documented that that was what was done by your doc. Check in the critical coding guidelines in your ICD-9 coding book first and go by that. Critical care should only be used when there is a life threatening condition or critical illness. First, ask yourself if the patient has either of those? Always make sure that your documentation supports your code selection.

 

[FTessaBartels]

Was patient admitted?

If the patient was already admitted (inpatient) to your facility ...
Option 1 - Critical care ONLY if the patient was critically ill and the care provided was critical care (doesn't sound like it from your description, but without the actual documentation it's hard to tell).

Option 2 - Subsequent Hospital Visit with prolonged service to cover the extended time spent with patient.


If the patient was in observation or in the ER...
Option 1 - Critical care (as per above caveats)
Option 2 - Appropriate outpatient E/M (new or established) with prolonged service to cover the extended time spent with patient.

Hope that helps.

F Tessa Bartels, CPC, CEMC