Wiki Coding ICD-10-CM in Radiology Inpatient Setting

[BrookeKraus]

Hello,

Any site I have worked at in the hospital setting has always used outpatient ICD-10-CM guidelines when coding radiological procedures even when the patient is inpatient. Why is this, what guideline supports this? Or should we be truly following IP guidelines if that patient is inpatient even when reporting the ProFee components?

 

[JulieP]

What would you advise then for a specialty practice that provides radiology procedures (ultrasounds) to hospital inpatients OUTSIDE of the hospital? The ultrasounds are performed by the specialty physician, in their office and on their own equipment. Results are interpreted and discussed face-to-face by the specialty physicians as well. We have always been told that this needs to be billed with Inpatient codes and place of service when it takes place during a true inpatient admission, even though the services are not performed in the hospital or by the hospital (private practice adjacent to hospital providing both components).

 

[Pam Warren]

Who is telling you to bill this way? Are you billing for your own imaging/reads, globally?

I think that the problem is that the hospital is sending the patient out of their hospital during the time when there's an inpatient stay going on, to your private outpatient office (regardless of where it's located) and they are not supposed to be doing that. When they're getting paid based on DRG, they need to provide all services, unless they're providing them under arrangement, which would mean you'd be paid by them and they bill (the technical charge anyway) for you.

I would advise to bill compliantly according to how you should do this for all other instances and if they push back, call Medicare.

What would you advise then for a specialty practice that provides radiology procedures (ultrasounds) to hospital inpatients OUTSIDE of the hospital? The ultrasounds are performed by the specialty physician, in their office and on their own equipment. Results are interpreted and discussed face-to-face by the specialty physicians as well. We have always been told that this needs to be billed with Inpatient codes and place of service when it takes place during a true inpatient admission, even though the services are not performed in the hospital or by the hospital (private practice adjacent to hospital providing both components).

 

[JulieP]

According to one of our largest commercial payers, "Outpatient services are treated as inpatient services unless documentation supports that they are clinically distinct from the reason for the beneficiary's admission."