Inpatient coding

freemans

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I am having a debate with a coworker and am reaching out for some clarity. How would you code this?

Jane Smith was admitted to observation on January 1st late at night for further work up of upper abdominal pain the
patient had been experiencing. Jane was not evaluated by the admitting physician until the next morning (January 2nd).
After the physician’s initial face-to-face encounter with the patient and review of her diagnostic studies it was determined
that she suffered from gall stones. Jane decided with her physician to schedule a cholecystectomy in the near future so
she could make arrangements at home. She was discharged later that day (January 2nd)....

The answer that was provided was....

These admission services cannot be coded until the provider performs a face-to-face-service. If the face-to-face service for
the admission occurs on the same date as the discharge, a code from the single-day observation service codes should be
selected. Because the physician provided both admission and discharge services on January 2nd, the appropriate code
selection would be CPT 99234 – 99236, dependent upon the documentation provided.

If the above answer is correct, how do we bill for Jan 1st? Is it we don't bill for that day?
 

mhstrauss

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I am having a debate with a coworker and am reaching out for some clarity. How would you code this?

Jane Smith was admitted to observation on January 1st late at night for further work up of upper abdominal pain the
patient had been experiencing. Jane was not evaluated by the admitting physician until the next morning (January 2nd).
After the physician’s initial face-to-face encounter with the patient and review of her diagnostic studies it was determined
that she suffered from gall stones. Jane decided with her physician to schedule a cholecystectomy in the near future so
she could make arrangements at home. She was discharged later that day (January 2nd)....

The answer that was provided was....

These admission services cannot be coded until the provider performs a face-to-face-service. If the face-to-face service for
the admission occurs on the same date as the discharge, a code from the single-day observation service codes should be
selected. Because the physician provided both admission and discharge services on January 2nd, the appropriate code
selection would be CPT 99234 – 99236, dependent upon the documentation provided.

If the above answer is correct, how do we bill for Jan 1st? Is it we don't bill for that day?


Was any service performed on Jan 1? It doesn't seem like that was. If no, what exactly are you trying to bill for, for Jan 1?
 

SarahEFox

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If the patient was admitted on calendar day of 1/1/17 and not seen by the physician until calendar day of 1/2/17, then you can not bill anything for the physician until DOS 1/2/17. Since the patient's admission and discharge crossed a midnight, you can not bill the same day admit/discharge code. The same day admit/discharge code can only be used if the patient is admitted and discharge on the same calendar day, and stays for more than 8 hours.

Per CPT Assistant 6/02:


"Question
A patient is admitted for observation before midnight. The physician does not see the patient until the next day, which is also the date of discharge. The physician performs the discharge examination, discusses the patient’s stay, and gives instructions for care following discharge. Should I report codes 99234-99236 for this service?

AMA Comment
From a CPT coding perspective, codes 99234-99236, Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, may be reported only when the patient is actually admitted and discharged on the same date of service. The physician should not report these codes when the patient is admitted one day and discharged the next day. In this case, the patient is in the hospital for two dates of service, so the physician should report the discharge services performed on the second day of admission, which is also the date of discharge."
 
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Coding question

I work in a long term care facility. I have a resident that went out on bed-retention the physician wrote that she is sending out for repair of the tracheocutaneous fistula. We do not do repairs here we have to send the resident out to acute for the repair. How would we code this?
 
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