Wiki Hospitalist DC and Admit Question

[abbypine]

When a hospitalist discharges a patient from their inpatient hospital stay, but then later that same date the patient returns and is admitted as an inpatient again, how would this be coded? Patient is in from 05/24 to 05/25 and then inpatient again later 05/25 until 05/30. If I code a Discharge on 05/25 and an H+P for when they came back it gets rejected. Thank you

 

[SharonCollachi]

Hospital services are a "per day" code, so you wouldn't bill a separate discharge day and an admission day for the same day. There is a same day admit/discharge code, but that doesn't apply here.

You will just bill the followup code of 99231-99233. The doctor wouldn't be doing the same amount of work for a readmission that they would have done on an admission, particularly the same day they left, unless something entirely different happened, like they got into a car accident on the way home.

You COULD bill both codes, and appeal, but again, unless it's an entirely different problem, you probably won't get paid on both.

 

[thomas7331]

I would probably bill both and then appeal the one that denied. The hospital will be requiring the admitting physician to do a complete H&P again and documentation will likely support a completely separate admission service. In theory it is less work but in reality, most hospitalist teams I've worked with have separate physician staff doing admissions from discharges, so it's usually going to be a different physician starting from scratch, which requires reviewing the entire history and creating a whole new care plan - whether they were discharged a month ago or a few hours ago isn't going to change the fact that they're doing all the work of both the admit and the discharge.