Hospital Transfer

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A physician performs 4 hours of critical care at a small local hospital then transfers patient to larger hospital in same day when condition worsens. At the larger hospital, the same physician (who has privledges at both) performs an Admit H & P and performs 4 more hours of critical care. How should this be billed? Can the same physician bill for hospital services at two locations on the same date of service?
 
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Keep in mind that critical care is not a "place" of service. CPT states that it is 30 minutes or more of direct patient care provided by the physician to a critically ill or injured patient, regardless of the location.

You should treat the second admission as 4 more hours of critical care.
 

donsqueen

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This is going to depend on how he is billing.

Scenario 1: Dr. is independant of either hospital, he will bill all services only once: Admit to new hospital (include all E&M services in figuring level) and 8 hours of critical care (if requirements in documentation and service provided met) {4 hours at 1st hospital followed by 4 hours at 2nd hospital).

Scenario 2: Dr. is employee of both hospitals and does not bill his professional services independantly: You MAY be able to bill a discharge level for the 1st hospital depending on documentation in addition to critical care for both and admit to 2nd.

Scenario 3: Dr. is independant of 1 hospital and employee of other. You MAY be able to bill same is in scenario 2.

Another option: You might also want to look at the prolonged care codes, especially if the documentation does not meet critical care.

Personally, the only way I would consider billing under scenario 2 or 3 is if the patient was discharged home from hospital 1 and then worsened and admitted to hospital 2. If patient was transferred, I would then go with scenario 1 regardless of employee status at either hospital.

I am also assuming here that the 2 hospitals are NOT part of the same hospital system.
 

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Thank you for the great info! Scenario 1 applies here as the physician in question is independent and not an employee of either hospital. The hospitals are not part of the same system either.
 
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