CCR/admit from ER (POS question)

spirving

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I am totally at a loss here. POS is documented in CPT but not alot of guidelines really. Are these possibly carrier requirements more than CPT requirements?

We are multispecialty. The pt has CCR services rendered in the ER by the ER doctor then is admitted by another physican (in our multispecialty group) to the hospital. What POS do I bill the CCR charges for? We are billing 23 because that's where services were rendered and they saw our ER provider. However, several carriers are denying these charges because pt was admitted. They want POS 21.... Thoughts? References?
 
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response to CCR/admit from ER (POS question)

admit = 21
eventhough the patient was seen in the ER, the ER visit is bundled into the hosptial stay

I am totally at a loss here. POS is documented in CPT but not alot of guidelines really. Are these possibly carrier requirements more than CPT requirements?

We are multispecialty. The pt has CCR services rendered in the ER by the ER doctor then is admitted by another physican (in our multispecialty group) to the hospital. What POS do I bill the CCR charges for? We are billing 23 because that's where services were rendered and they saw our ER provider. However, several carriers are denying these charges because pt was admitted. They want POS 21.... Thoughts? References?
 

spirving

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admit = 21
eventhough the patient was seen in the ER, the ER visit is bundled into the hosptial stay
That's true when they're the same specialty group. However, this is a physician who is board certified and credentialled as an ER doc vs being admitted to a physician credentialled as an Endocrinologist. In this case, the ER docs charges are not wrapped into the Endocrinologists charges. Or at least that is my understanding. Am I wrong?
 
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yes you are wrong...any visit resulting in an admission is bundled into the admission and the POS is 21

That's true when they're the same specialty group. However, this is a physician who is board certified and credentialled as an ER doc vs being admitted to a physician credentialled as an Endocrinologist. In this case, the ER docs charges are not wrapped into the Endocrinologists charges. Or at least that is my understanding. Am I wrong?
 
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cpt book beginning of e/m and the CMS website here is an example

[PDF] CMS Manual System Department of Health & Human Services (DHHS) Pub ...
... When a beneficiary receives outpatient hospital services during the day immediately
preceding the hospital admission, the outpatient hospital services are ...
www.cms.hhs.gov/transmittals/downloads/R1429CPTXT.pdf - 2008-02-02 - Text Version
[ More results from www.cms.hhs.gov/transmittals/downloads ]


Where is that documented? Thx.
 
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spirving

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cpt book beginning of e/m and the CMS website here is an example

[PDF] CMS Manual System Department of Health & Human Services (DHHS) Pub ...
... When a beneficiary receives outpatient hospital services during the day immediately
preceding the hospital admission, the outpatient hospital services are ...
www.cms.hhs.gov/transmittals/downloads/R1429CPTXT.pdf - 2008-02-02 - Text Version
[ More results from www.cms.hhs.gov/transmittals/downloads ]
The CMS website specifically states Part A which is facility and that make sense. I'm not sold on the physician though, that's why physician's have different credentialls so that they can bill differently from each other and not all lumped together. The CPT breaks down bundling of codes when it's the same doctor or doctor of same specialty/group. What I have is two different specialties who are credentialled by the state and by the carrier as different types of providers. They should be coded differently for CPT, I'm just questioning POS. When the ambulance takes someone to the hospital, they don't bill POS 21 because the pt was eventually admitted, they bill the POS where services were rendered.

I'm definitely not trying to argue, I appreciate your feedback. It's alot of information to consider. I think I will take this to our coding compliance dept for a review. Thanks.
 
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