Wiki for inpatient E/M BILLING

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farheenkirmani

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Dear all when using the e/m inpatient codes the billing will be same as outpatient office visit billing or different.also need guidance in which cases we use drg billing and in which cases is given preference for inpatient e/m codes
 
I am confused by your post. If you are a physician coder you do not perform DRG coding and you always follow physician E&M guidelines and use the appropriate physician codes for the setting. If you are coding inpatient facility, then you not use physician E&M codes.
 
Also, if you are billing for physician, as opposed to facility, and pt is inpt hosp, then the billing would not be the same as outpt office billing. You have a whole separate range of codes for inpt vs outpt office/hosp. I guess we're not quite sure what exactly is the question. Can you give more details?
 
Inpatient billing of e/m

Actually i m working in hospital having outpatient ,er, inpatient all types.my question is that for outpatient and er billing part is very clear just i am bit confuse about billing part in inpatient as we will be using first time inpatient e/m codes before we are using only drg.i want to know for the same patient can we use inpatient as well as drg or not in inpatient setup.please guide as per my knowledge we can use either one not both together is this correct or not
 
Where are you getting the information that the facility uses E&M codes for inpatient ? Because they do not unless this very new and i can find no information if it is. Inpatient reimbursement is DRG payment which is diagnosis based.
 
Are you billing for the physician's charges or the facility's services? Even if you work for a hospital, there are two different kinds of billing.....facility coding/billing and physician coding/billing. Make sure you're clear about the differences.

I'm going to assume you're billing for the physician. You do not concern yourself with DRG when you submit your charges for physician services using E&M. DRG is calculated from diagnosis codes that are extracted from physician documentation, but is used to report the facility stay....not the physician's work.

So for the physicians in the inpatient setting, you bill the appropriate E&M codes for inpatient services (99221-99223, 999231-99233, 99251-99255, 99234-99236, for example) depending on the situation, documentation guidelines and payer guidelines.

If you are billing for the facility (abstracting the DRG for inpatient services done throughout the admission), then you probably won't be able to get much direction from this discussion board, because most of us are physician coders. But I do know that E&M levels of service are not a consideration with regards to facility inpatient billing/coding.
 
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