Wiki Can you bill a an outpatient cpt code with an admission?

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jeremybcabarloc

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Hello all,

Is it possible to bill a 99220 or 99217 or when the patient has been admitted and has an admission date and a discharge date?
 
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I'm not sure what the rationale is. I've been working on medicare denials and I noticed a trend. Claims are being denied for missing/incomplete/invalid type of bill. On these claims, two physicians have submitted claims for the same dos,Another physician who isn't ours is billing an inpatient cpt code 99223 and their claims are being paid. Our physician is billing a cpt 99220 and their claims are being denied. Also, we have an admission date for the claim.
 
you will need to see the documentation. You should not have one provider billing observation and another billing inpatient. Now if both providers are in the same specialty and same tax ID, and one admitted to observation and the next one comes around and admits to inpatient, then only the inpatient can be billed.
If these are two different practices then the question becomes how did your provider that admitted the patient to observation, document the encounter. Because you provider. Would need to either transfer care or discharge the patient befor a provider from a different practice could admit the payient inpatient.
If the payient was admitted to inpatient first, then your provider cannot be charging observation.
 
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Would this change is the two providers have different specialty codes? Our physician is a hospitalist code#11 and the other physician is a neurologist code#13
 
Not really. The provider that admits the patient to observation must be the one that discharges the patient from observation before they can be admitted to inpatient by a different provider.
 
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