Wiki Office visit and hospital admission - same day - same provider - different group

[tfinertie]

I work as E&M auditor for hospitalists. I have a hospitalist who works for our group, but also works in an outpatient clinic for another group. He saw a patient in outpatient clinic and later the same day, admitted the same patient as inpatient hospital. Since it is two different groups (different TIN) but same clinician, can both E&M codes be billed (99214 under outpatient group, then 99223AI under hospitalist group)?

 

[kbartrom]

No, even though a different TIN, it is the same physician. From Medicare's Claims Processing Manual:
B. Initial Hospital Inpatient or Observation Care on Day Following VisitA/B MACs (B) pay both visits if a patient is seen in the office on one date and admitted to thehospital as an inpatient or receives observation care on the next date, even if fewer than 24hours has elapsed between the visit and the admission for hospital inpatient or placement inobservation care.