IP vs Observation

[NESmith]

I have a provider who was aksed to see a patient in the hospital for an evaluation of the patient's abdominal pain. The patient has a incarcerated inguinal hernia with small bowel obstruction. The provider billed CPt code 99222. The biller is stating the patient per the hospital was observation and he should be billing a different CPT code. How owuld the provider know this and what code should he have used. Thanks for your help.

 

[mitchellde]

Observation or ip status is dependent on the physician order in the chart. You will need to obtain a copy of the documentation in the patients hospital chart for the day of admit to see if it states admit patient or admit to observation. This will be the determining factor. If the hospital UR determined after discharge that the patient met the criteria for observation then they are allowed to query the physician to obtain an order to convert the stay to observation, this too must be documented in the chart. If this has occurred then you must submit a corrected claim for your visits.

 

[NESmith]

Thank you for your reply but then what would be the correct CPT code to bill if the visit turned to observation instead of IP?

 

[mitchellde]

I am out without my CPT book but if you look in the E&M section there are codes for Observation admit and discharge. You will also change the POS to 22.