Good afternoon everyone.
I work for a hospitalist group. We have an observation status/service here at the hospital. There has been a lot of discussion about the appropriate way to bill conversions within observation and inpatient.
The easy scenerio is if a physician admits a patient to observation status and then through the course of the admission the patient's condition deteriorates the physician and hospital know to convert the patient to inpatient status from that moment forward.
Example:
2/13 - patient admitted to observation for chest pain - bill 99218-99220
2/14 - patient is found to have MI so is converted to inpatient - bill 99221-99223
2/15 - patient is still in hospital for monitoring - bill 99231-99233
2/16 - patient cleared for discharge - bill 99238-99239
The not so easy scenerio is if a physician admits a patient to Observation on 2/13 but then the UR company calls on 2/14 and says the patient should really be inpatient from the beginning. Do we as physicians bill the entire visit as an inpatient or do the inpatient bills start on 2/14?
Also, if a physician admits a patient to inpatient but then the UR calls and says that the patient should be observation, do we bill observation from the beginning or do we just start at the point of review? I know that the hospital uses condition code 44 but what about us as physicians? How do we indicate the change in status/service?
I hope that this makes sense to someone! I would really like some clarification!
I work for a hospitalist group. We have an observation status/service here at the hospital. There has been a lot of discussion about the appropriate way to bill conversions within observation and inpatient.
The easy scenerio is if a physician admits a patient to observation status and then through the course of the admission the patient's condition deteriorates the physician and hospital know to convert the patient to inpatient status from that moment forward.
Example:
2/13 - patient admitted to observation for chest pain - bill 99218-99220
2/14 - patient is found to have MI so is converted to inpatient - bill 99221-99223
2/15 - patient is still in hospital for monitoring - bill 99231-99233
2/16 - patient cleared for discharge - bill 99238-99239
The not so easy scenerio is if a physician admits a patient to Observation on 2/13 but then the UR company calls on 2/14 and says the patient should really be inpatient from the beginning. Do we as physicians bill the entire visit as an inpatient or do the inpatient bills start on 2/14?
Also, if a physician admits a patient to inpatient but then the UR calls and says that the patient should be observation, do we bill observation from the beginning or do we just start at the point of review? I know that the hospital uses condition code 44 but what about us as physicians? How do we indicate the change in status/service?
I hope that this makes sense to someone! I would really like some clarification!