Wiki Place of service/facility question

[lindam@caricures.com]

I work for a surgeon. Sometimes he gets called to the ER to see a patient. Sometimes the patient gets admitted, sometimes they might have a procedure and discharged. I am always confused about POS/Facility.
If I use POS as ER, and Facility as Out Patient Hospital, I have gotten denials. For instance, we recently had a patient go to the ER for rectal pain. On examination by my provider he was found to have a perirectal abscess, which was drained at bedside. I want to code for the I&D of the abscess - do I use POS as ER?

 

[csperoni]

The POS and facility should reflect the patient's status at the time care is rendered. The status is not always the same as the physical location of the patient.
In your example, if a clinician already wrote orders to admit the patient, then the POS/facility would be hospital inpatient, even if the patient was physically in the ER awaiting a bed on a floor. If the patient was not being admitted, then use POS/facility as hospital ER.

 

[lindam@caricures.com]

The POS and facility should reflect the patient's status at the time care is rendered. The status is not always the same as the physical location of the patient.
In your example, if a clinician already wrote orders to admit the patient, then the POS/facility would be hospital inpatient, even if the patient was physically in the ER awaiting a bed on a floor. If the patient was not being admitted, then use POS/facility as hospital ER.

I have a follow up question to this. A patient is in the ER - not "technically" admitted, in the Emergency department - our Doctor went in to do a consult about whether they should be admitted - not admitted - in "observation" I guess. Do I bill as an ER visit 99285? or initial hospital visit 99223. These things confuse me. What is "admitted", "observation" - our hospital doesn't seem to use that word, or Emergency Room.