Wiki ED + Inpatient on same DOS?

[astuart@pmsia.com]

Hi All,
We are getting some conflicting information regarding the CAH rules.

How would you code the following scenarios:
1) Patient seen in ED and admitted to inpatient on same DOS (same physician does both ED and admission)
2) Patient seen in ED and admitted to inpatient on same DOS (different physicians perform ED and admission)
3) Patient seen in ED and admitted to Observation.

Also, if coding for both ED and initial hospital care, does the physician need to have 2 separate notes?

Thank you for your help in advance!

 

[sivagurulingam]

Hi,

Scenario 1. Billed with initial hospital visit by ED provider because when both ED and initial visit rendered by the same physician, only one visit allowed as per CMS process manual chaper 12.
Scenario 2 . Billed with ED visit to ED provider and initial hospital visit to another provider (not by another provider of the same ED department) who admit the patient.
Scenario 3. Bill initial observation care code if both rendered by ED provider.