Question Need Immediate Help Please

Clara1203

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I have a provider who is fighting me on billing an outpatient follow up as a discharge because he spent more than 35 minutes discharging the patient. I know this is wrong and I have told him that this is fraud. Now he is asking his "expert" person in coding in regards to this. I know he is going to come back and say that he was right and that I was wrong. Can someone send me something that supports what I am saying?
 

mitchellde

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Where was the patient, was it an inpatient setting, outpatient observation or office visit. When you say discharging the patient and outpatient follow up those seem like two different things.
 

Clara1203

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The patient was seen in a observation setting. The provider thinks that he can use an observation follow up as a discharge code because he spent more than 30 minutes with the patient.
 
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CPT codes 99238 and 99239 are reserved for inpatients. Per the parenthetical description under the codes in CPT, "These codes are to be utilized to report all services provided to a patient on the date of discharge, if other than the initial date of inpatient status." If your provider admitted the patient to observation status, then 99217 may be appropriate. If the patient was truly outpatient, then your provider should report the appropriate outpatient E/M code 99201-99205 or 99211-99215.
 
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