Wiki When OP become admitted to IP.

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stephanie7480

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OK forgive me if this is a newbie question but I need clarification about physician billing for a patient who, for example comes to the hospital ER and stays for 2 days in outpatient status then on the 3rd day is admitted to inpatient. When the physician bills (not the facility) would this be:
Day 1 (op)=outpatient initial visit code
Day 2 (op)=outpatient subsequent visit code
Day 3 (ip) = initial inpatient code or subsequent inpatient code ??

Thanks in advance for your help
 
Let me rephrase my question:

stephanie7480 said:
OK forgive me if this is a newbie question but I need clarification about physician billing for a patient who, for example comes to the hospital ER and stays for 2 days in outpatient status then on the 3rd day is admitted to inpatient. When the physician bills (not the facility) would this be:
Day 1 (op)=outpatient initial visit code
Day 2 (op)=outpatient subsequent visit code
Day 3 (ip) = initial inpatient code or subsequent inpatient code ??
Or turn Day 1 into initial IP code and code subsequent visits there after.

I know that facilities turn the whole thing into inpatient but what about physicians that see the patients. I'll also need supporting documentation.

Thanks in advance for your help
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If your physician ordered the Observation Status:

Day 1 - Initial Observation Care

Day 2 - Subsequent Observation Care

Day 3 - Initial Hospital Care



Other physicians use office/outpatient codes:

Day 1 - Est/New OV

Day 2 - Est OV

Day 3 - Initial Hospital Care



Supporting documentation can be found in the E/M section of CPT and from CMS.

Highmark Medicare Services offers this training handout:
https://www.highmarkmedicareservices.com/calendar/partb/pdf/ws-observation-required-april11.pdf

Also, the February 2011 Coding Edge has an article on subsequent services of observation coding.
 
The presentation you provided the link to is awesome and answered my question. This is how I read it in the CPT but I need something from our MAC to present to my manager and the physician to educate them. I raised this issue over a year ago and I was told that I was wrong even though the Medicare Customer service rep told me the same thing. I'm frustrated because we are losing out on lots of revenue as a result.
Also what issue of Edge Blast are you referring to?
 
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