Billing for Surgeries

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3
Location
Arlington, TX
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My provider saw a patient while in obs status and during that time patient had to be admitted to the hospital for surgery but the inpatient order was not written until later that day. Should the surgery for the physician be billed as inpatient or outpatient? The surgery was not an inpatient only surgery. We have been receiving denials from Medicare stating that the POS was incorrect because the patient was admitted to the hospital but my provider is stating to appeal these because we have to bill the surgery for the status at the time of the order but I don't think this is correct, does anyone know of any Medicare regulations that address this issue or where I can find documentation to suport billing the surgery as inpatient even though at the time of the surgery the patient was in an observation status.
 

cgaston

Expert
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494
Location
Clarence, NY
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I think the issue is that the insurance carrier just sees the date of admission (not what time the admission occurred) so anything performed on that day would be inpatient.

Your provider is technically correct, but I personally would just change it to inpatient since the record reflects that admission occurred on that day and the service was performed between the dates of the inpatient stay.

I would ask your provider if he wishes to continue spending more time and money trying to prove to the insurance company why he is right or if he would rather just change the place of service to get the claim paid.

This is just my personal opinion...your mileage may vary. :eek:
 
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