Wiki Inpatient Admission and initial contact by admitting physician

[pedscoder21]

Our coding compliance manager has some of my coworkers and I perplexed. She is stating that if an admission occurs before midnight, let's say at 11:30pm, and the admitting physician sees the patient after midnight, let's say 12:05am, then we cannot bill an initial inpatient admission code. Instead, she says we have to bill it as a consult..........

She says that this is clearly written in the CPT book. The paragraph she referred to in the CPT is under the Initial Inpatient Admissions guidelines that describes services by the same physician occurring on the same day at different places of service.

Please, give me your feedback on this! Every source I have found says the opposite. And the way I read the CPT book is that you bill an initial inpatient admit code when the first face-to-face encounter happens with the admitting provider (regardless of date).

I even found an article on Today's Hospitalist that gives this very example... Link: http://www.todayshospitalist.com/index.php?b=articles_read&cnt=2025

 

[danskangel313]

A patient isn't considered inpatient until a formal order from a (qualified) provider for inpatient admission is made.

My question for you is, how was the decision to admit made if the admitting provider didn't see the patient first? In order to bill for an admit, you have to complete the normal components of HX, Exam, and MDM. Also, was the admit done during the course of another encounter in another location in the hospital (eg, the ED)?