Wiki Same Day Admit/Discharge by Different Doctors of the Same Group/Specialty

[lilleyea]

Good morning,

I had a strange situation that I was hoping I may get some guidance on...

The patient was admitted by the ED doctor to observation status before midnight. After midnight, the Hospitalist formally admitted the patient to inpatient status. Later that same evening, another Hospitalist in the same group discharged the patient.

I bill for the Hospitalist group, so I am not sure what the ED group billed for. I would assume that since the ED doctor documented ED observation admission, they would have billed 99218-99220. So the next morning, when the Hospitalist admitted the patient to inpatient status, do we just bill the initial inpatient charge 99221-99223? And then the discharge later in the day by a different hospitalist is just not billable at all? Any advice or guidance would be much appreciated!

Thank you!

 

[kathrynw]

Hi,
Since the Hospitalist formally admitted the patient as inpatient you would code as such since you are coding for the Hospitalist only. That being said using the information provided I would look at codes 99234-99236. As long as the first hospitalist documented a full E/M and didn't just write an order, they would get the credit.

Review the documentation along with the chapter specific guidelines to verify.
Range Specific Guideline
The following codes are used to report observation or inpatient hospital care services provided to patients admitted and discharged on the same date of service. When a patient is admitted to the hospital from observation status on the same date, only the initial hospital care code should be reported. The initial hospital care code reported by the admitting physician or other qualified health care professional should include the services related to the observation status services he/she provided on the same date of inpatient admission.

When "observation status" is initiated in the course of an encounter in another site of service (eg, hospital emergency department, office, nursing facility) all evaluation and management services provided by the supervising physician or other qualified health care professional in conjunction with initiating "observation status" are considered part of the initial observation care when performed on the same date. The observation care level of service should include the services related to initiating "observation status" provided in the other sites of service as well as in the observation setting when provided by the same individual.

For patients admitted to observation or inpatient care and discharged on a different date, see codes 99217, 99218-99220, 99224-99226, or 99221-99223, 99238 and 99239.

Hope this helps,

 

[lilleyea]

Thank you for your response.

My other question is may the admitting Hospitalist report 99234-99236 if a different Hospitalist performed the discharge? They are in the same group/specialty, so I know that Medicare considers them the "same provider", but then the Medicare guidelines also state:

D. Documentation Requirements for Billing Observation or Inpatient Care Services (Including Admission and Discharge Services)
The physician shall satisfy the E/M documentation guidelines for admission to and discharge from inpatient observation or hospital care. In addition to meeting the documentation requirements for history, examination and medical decision making documentation in the medical record shall include:
• Documentation stating the stay for hospital treatment or observation care status involves 8 hours but less than 24 hours;
****• Documentation identifying the *billing physician* was present and personally performed the services; and****
****• Documentation identifying the admission and discharge notes were written by the *billing physician*.****

For the second and third bullets, if the admission and discharge notes were written by 2 different billing physicians of the same specialty/same group, can we still report 99234-99236? The way that Medicare has worded it has thrown me off this time!

Thanks for all replies!