Wiki Outpatient procedure vs. Inpatient coding

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Good Afternoon,

I am a practice manager for an OB-GYN practice needing some help. We perform many GYN procedures on an outpatient basis but the hospital claims we need to bill them as inpatient since specific CPT codes are designated as inpatient per CMS. Intuitively, this makes no sense to me. Why would we bill something out as inpatient when the patient is released same day? It feels fraudulent to me to do this.

Any takers on this one?

Thanks,

Teri Werder, MHA, CPC
 
It is correct that some services are deemed inpatient only. If the provider orders an inpatient admit then it is an inpatient regardless of the length of stay. If the service is performed outpatient with no order to admit to inpatient then it cannot be billed as an inpatient event, even if that is the only way the payer will pay.
 
It is correct that some services are deemed inpatient only. If the provider orders an inpatient admit then it is an inpatient regardless of the length of stay. If the service is performed outpatient with no order to admit to inpatient then it cannot be billed as an inpatient event, even if that is the only way the payer will pay.

Thanks Debra, as the provider, we are scheduling it as outpatient because the patients do not need to stay overnight. How should I as the provider bill my claim? Do I bill as inpatient and have date of discharge the same day?

Thanks so much for your response.
 
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If the patient is scheduled as an outpatient then you must use the 22 as your POS for outpatient. The problem is if the procedure is one the payer has deemed an inpatient only procedure then you will not be reimbursed and you will not be able to be paid. You also would not be able to bill the patient. If it is an inpatient only procedure then you will need to go thru the process of admitting the patient prior to the procedure.
 
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