Wiki Using inital inpt code for estab patient


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Could someone clear up my head on this one? We don't normally have this scenario, but our provider is following someone for sx management. They initially saw pt in hospital, pt was discharged to home. There have been multiple followup visits in the pt's home. However, pt has returned to the hospital: should we bill initial again for the first hospital visit? Since we normally do only one-time consults, I'm not up to speed on following pts in & out of hospital. I think I understand that we can bill initial again (one per admission) since code clearly states new or established, but provider circled followup code. Also, once they go back home and provider follows up there, do we then bill established? THANKS!
You could bill an initial visit each time the PT is hospitalized. Just remember to have the admitting physician use the -AI modifier so you can each be paid for an initial visit. When the PT is seen as an outpatient, then you would use the established PT codes
What do you mean by

What do you mean by "for sx management"?

If your provider was the surgeon (or is in the same practice and same specialty as the surgeon), then any follow-up is covered by the global period.

If your provider was NOT the surgeon, and is not in the same practice and the same specialty as the surgeon, then there are a couple of scenarios:
1) your doctor is providing the post-op management .... surgeon bills procedure with a -54 modifier; your doctor bills the same procedure with a -55 modifier.
2) your doctor is NOT providing post-op management, but medical management for a patient who has had surgery (for example, pt is diabetic and had rt great toe amputation by orthopaedic surgeon, but YOU are just dealing with the diabetes) - you would code for any face-to-face visits with the patient, using your appropriate diagnosis.

Hope that helps you.

F Tessa Bartels, CPC, CEMC
Sorry, this is a pt with terminal illness. Our provider was asked to take over pain/sx management during the 1st hospitalization, so this is for palliative care, not follow-up for a global period. My understanding is that if our provider sees them during a 2nd hospitalization, they can bill another initial for that 1st inpatient visit. Just wanted to make sure since we don't normally have pts going in/out; the response above also indicates we go back to established for outpatient services. Thanks!