Wiki Billing for procedures performed in office then direct admitted to hospital


Hahira, GA
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We recently treated a patient in the office w/ xrays which showed a lumbar lesion who was displaying cauda equina symptoms. We subsequently ordered a stat MRI. On the date of the MRI (performed in our office, but the interpretation was done by an outside physician-so it was billed with the TC modifier, POS 11), we also saw her in-office for the results. Due to the findings on the MRI, our physician direct admitted the patient to the hospital and continued to treat and order additional testing on the same day. I know that according to coding guidelines, we are to bill for the initial inpatient hospital care and not an office visit EM code. However, my concern is what, if any, issues will arise since we performed the technical component of the MRI on the same day of admission? It is my understanding that if the technical component of a radiology service is billed during a patient's inpatient stay, then it is not payable. Is there a way around this? We have several patients that we perform x-rays on in office and then direct admit to the hospital since we are an orthopedic and spine practice. Also, does this same issue apply to procedures performed in office (for example, aspirations or injections) when the patient is subsequently direct admitted?
As long as your practice is not owned or operated by the hospital, the services you provide prior to admission are not part of the inpatient payment. I would not expect you to get denials for your services done in the office on the day of admission, but if you do, you should appeal with documentation showing that they were done prior to the time the patient was admitted. After the admission and during the inpatient stay, if you happened to perform any services with a technical component for that patient, then you would need to invoice the hospital for reimbursement for those.