Wiki Discharge & Re-Admission Same Day - Unrelated

[tdewitt]

I need to see if anyone can help with an odd coding situation:

Dr. discharged a patient from the hospital in the morning. Patient went home... FELL DOWN that afternoon... and was re-admitted for reasons related only to the fall that afternoon...NOT related to the reason for which he was in the hospital for before.

Patient has Medicare. How would you code the services provided that day:

1) discharged in morning
2) re-admitted late afternoon for problems not related at all

Is there a modifier that can be used...or are we just out of luck on this one??

Thanks!
Tammi

 

[espe29]

Hi, you never mentioned if your Dr. performed any surgery or procedure on the patient at all on the first admission. There are new rules for E/M from CMS effective 1/1/2010. Anyway if you are trying only to bill the E/M visit you need to make sure you use the new codes after 1/1/2010.Now, I believe because the diagnosis from the discharge is going to be different from the admission Dx within the same day I don't think you will need a modifier to bill for the second claim. However if your Dr. performed any type of surgery and discharged the patient and then admitted the patient for rasons unrelated to the original surgical procedure then use Modifier 24 for the admission E/M code (e.g. hip procedure on first admission, but then patient have a knee problem ).I hope this helps.

 

[LLovett]

I'm going to assume there was no global period since you want to charge a discharge in the first place.

Problem is discharge, admit, and subsequent care codes are all per day codes so you really can't have a discharge and an initial on the same day. Unless you have providers in different specialties.

I am going to assume it is the same provider who discharged that is re-admitting. In that case I would just use a subsequent care code.

Laura, CPC, CPMA, CEMC