Office visit and admit same day

kemptar

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New Brighton, MN
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In the event that a provider sees the patient in the clinic, decides to admit the patient to the hospital, and another provider from the same specialty assigned to the hospital has the face-to-face encounter with the patient that day, can the initial provider whom does not carry out the face to face portion bill for the admit (99221-99223) as he is doing all of the work-up?

The confusion lies with Medicare viewing each specialty as a single provider, so only one provider can bill that day, but we are unable to find any reference specifically stating that the initial provider has to have the face to face visit with the patient in the hospital as opposed to the partner at the hospital.
Any insight would be greatly appreciated.
 

ARCPC9491

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Stafford, VA
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Whoever admitted the patient would bill for the admit H & P - 99221-99223. Is the provider of the same specialty in the same group?
 

kemptar

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New Brighton, MN
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The doctor in the clinic did all of the documentation, a full history, exam etc. and decided to admit the patient that day for treatment. The doctor already in the hospital is from the same group and same specialty. Our clinic is attached to our hospital by the way.
 
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ARCPC9491

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Stafford, VA
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Whoever put the orders in for admission and did the admit H&P bills for the admit. You won't get paid the visit in the clinic. The physician in your group who say the patient subsequent to the admission, but same calender day, won't get paid the subsequent visit since it's the same group, same patient, same day, same diagnosis? you could try to appeal it, most carriers will deny. Good luck!
 
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