Inpatient admission/discharge documented on the same day

pJohnson15

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I have a question on patient that was admitted to inpatient (by the ED physician) on 1/7/20 at 8:45, but not seen until the next day by the hospitalist. The hospitalist's initial hospital care note and his discharge note are on the same DOS (1/8/20.) I know we can only bill 1 E/M per day, per specialty. Since the patient was technically admitted on the 7th, we can't use same day codes. How would we code in this instance, and where would I find documentation that shows this? Thank you.
 

SharonCollachi

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Was the patient actually admitted by the ED physician, who would then do the work of the admission and bill the admission? I thinking probably not, since the patient can only be admitted once for the hospital stay (not once by the ED physician and once by the hospitalist). If the hospitalist did the actual work of the admission and the discharge on the same day, I would use 99234/99235/99236, as the stay was longer than 8 hours (else use the admit code only).

Remember that the "initial hospital care" is used to report the first hospital inpatient encounter with the patient by the ADMITTING physician, per CPT book.

Sharon
 

pJohnson15

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Thank you for your response. I am being told that the ED physicians have admitting privileges, and the hospitalist then will see the patient on the next day and do the H&P. Sometimes, they are also discharged later in the day.
 

SharonCollachi

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Who is doing the admitting work? Meaning, writing the orders that are needed for an inpatient stay... labs, meds, nutrition, etc.? If it is the ED physician, he bills the admission on the day he did the work, which would be day one. If he transfered care to the hospitalist after that, then the hospitalist bills a subsequent visit (99231-99233) on his first face-to-face. If his first f-to-f is to discharge the patient, then he would bill the discharge code (99238-99239). Since he is not doing the admission himself (I'm guessing), he cannot bill a same day admit-discharge (99234-99236).
 

pJohnson15

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The ED physician is writing the order to transfer the patient to inpatient status. All other orders (labs, meds, nutrition, etc.) are written by the hospitalist when they are seen the next day for the first face-to-face visit. When they are discharged, the hospitalist sees the patient again and determines they are ready to D/C.

Sorry for all the questions, this is a weird situation that I haven't encountered before. I do appreciate you taking time to respond Sharon.

Pam
 

SharonCollachi

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Clovis, CA
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In this situation, my vote is that the hospitalist bills for the admission. If his face to face is on the same day as discharge then bill the 99234-99236 codes.
 
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