Wiki ED agreement with Obstetrics

[BS&SC]

I have been told by my manager that we have an agreement with the Emergency room that they will not charge the E&M for admissions when it is a patient of our practice, so that we can charge the initial inpatient using the hospital personnel's H&P. I have not seen this agreement and am hesitant to code off of just my manager's word. Do I have a right to ask to see this agreement?

 

[thomas7331]

I think that this is a fairly common arrangement between OB physicians and emergency rooms, but I'm confused as to why you would need to see that agreement, if there in fact is one in writing. Your coding would only be based on your physician's encounter notes, and any written agreement should have no bearing on how you select your codes. Your payers and/or auditors will not have access to any kind of agreement like this either, and they will also validate your claims based on the medical records alone.

 

[BS&SC]

So if my physician has in the A/P to admit, I can bill with the AI mod, correct?

 

[thomas7331]

So if my physician has in the A/P to admit, I can bill with the AI mod, correct?

If your physician is the attending for the inpatient admission, then yes, bill the admit code with the AI modifier.

You really don't need to worry about what the ED physician is doing. They would only bill an admission code if they were going to supervise that patient during the stay. I've seen some observation cases where the ED providers will oversee the entire observation stay and not involve any other physician, but I've never seen an ED provider bill for an inpatient admission. They will just bill the ED codes for any services they perform before the attending physician takes over the admission.