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Observation with Cardiac Cath on same day

crhunt78

Guru
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154
Location
Olathe, KS
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Does anyone know where I can find information on admitting patients to observation status and doing a cardiac cath on the same date of service? I know that this is not allowed unless the patient is admitted to inpatient status AFTER the cath but I need something in writing to show our physicians. We have a couple of physicians who always try to code a level 3 observation stay along with a cardiac cath procedure and I need some kind of documentation to present to them to show that billing for an observation admit with every cardiac cath procedure is not allowed. Thanks for your help in advance!
 

amym

Guest
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241
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I myself need to know this as our physician is billing observation and discharge same day as CATH.
 

crhunt78

Guru
Messages
154
Location
Olathe, KS
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I believe the answer to our question is that no, a cardiologist may NOT bill an observation stay on the same day as a cardiac cath procedure. The patient's history and physical were already taken when the intervention was scheduled and any minimal exam performed before or after the procedure is already included in the procedure itself so billing for observation would be double dipping.

Is your physician coding an obs. and d/c every single time they do a cath?! If so, look at the Medicare Claims Processing Manual and look up the Observation coding rules. I also found info on our local Medicare Carrier's website about billing an inpatient vs. an observation patient. There is specific documentation that is required for each type of E/M service. A patient must be admitted to inpatient status due to complications from the cardiac cath AFTER the procedure is performed.
 
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