Wiki Pt admitted from ER next day


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Good morning,

I understand that if our physician see's his patient in the ER and then admits them, we bill for the admission/ initial inpt visit and not and ER visit.
Our Psych physicians are, we think, confused and this is making us confused! We'd like to get them on the right track, but want to be sure of what we tell them.

This is the typical scenario: 5/9/17 MD see's the patient in the ER and bills an ER visit - his note states pt is to be admitted. On 5/10/17, another physician in the same practice bills a charge for a subsequent hospital visit and another physician then documents the Certificate of Admission for 5/10/17 - Yet another physician in the same practice bills a charge for 5/11/17 as the initial inpatient visit!!

I think that the initial inpatient visit would be 5/9/17 and the rest of the visits subsequent. Or does the admission cert date play a role in determining when the ER visit is billed as an ER visit and not an admission?

Any help or guidance is very much appreciated!

My understanding is that a patient becomes 'inpatient' at the time the order is written to admit the patient, not at the time the documentation is completed. So if the physician orders the admission during or on the same day as ER visit, the E&M for that date would be coded as an initial inpatient E&M service. Services performed by the same physician and/or specialty the next day would be subsequent.
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