Wiki Nursing home admit after surgery


Baker City, OR
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I am working in a critical care access hospital (which is tricky in it's self). I do the coding/billing for the physicians.

We have what is called “swing bed”, which is the coded with the CPT Nursing Home codes. Our surgeons have started discharging their patients from acute care after their surgery, and admitting them into swing bed for rehab purposes.

The patient is still in the hospital, but the physician does not see them every day, like when they are in the nursing home. The hospital nurses take care of the patient, and they are seen by physical therapy.

One of my docs wants me to start billing for nursing home admit/discharge for these patients. Is this included in the global package, or should I be billiing for this? Also, I am hoping to find supportive documentation on this subject as he is very persistent.

Thank you for any help.

This should be included in your postoperative care. I do believe your RBRVs book where you find your postoperative care days has an explanation of the global surgical package. The fee the physician recieves from the insurance company includes payment for pre surgical care, the operation, and post surgical care until the global period is over. The exception to this is if the patient is being treated for an unrelated problem.
Hi Debbie, I also work for a CAH in the Physicians billing office. I agree with the above comment. If the pt is there for rehab only from surgery, the surgeon cannot charge. If the pt has new onset afib or pneumonia then the surgeon would call for a consult from either the internal Docs or family medicine or hospitalist. I would use a 24 if it was one of the oncall docs that I bill for. Please feel free to email me. I have been doing CAH for 2 yrs in March. Good Luck.