Wiki where can I turn for help

[dsmith06351]

I have told our doctors that we cannot bill the initial hospital visit on the day that we admit the patient from the office, if we did not go to the hospital. At a recent seminar the instructor said that if the doctors are dictating the admit note and then faxing it to the hospital so that when the patient arrives they can be directly admitted that we can bill the initial hospital visit instead of the office visit. Where do I find out what is the correct way? I need to have a concrete answer to bring back to the doctors.

Any help would be greatly appreciated

Denise Smith CPC-A, CEMC

 

[sbicknell]

This is a paste from CMS:
When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.

It is better--and you want him to code--the "direct admit" encounter as an initial inpatient. Look at it this way, your Physician only gets one E&M service per day (generally). He can code the OV or he can code the Initial inpatient.

If he codes the OV E&M, it will probably be denied as records will show was patient was Inpatient status on that DOS.

The initial inpatient E&M codes generally have a higher RVU and reimbursement than the OV E&M (depending on level coded).

 

[Anna Weaver]

If you look at the codes 99221-99223 in CPT the description indicates "Physicians typically spend xx minutes at the bedside and on the patient's hospital floor or unit." So, we do not let the physicians charge an initial visit unless they present themselves to the hospital. If they admit from the office and do not present to the hospital, charge the office visit (per documentation) and then the next day, when the physician sees the patient, charge the initial visit (per documentation).

 

[sbicknell]

Here is a suggestion on explaining this to your Physicians............

Monday, see patient in office at 10 am
Decide to direct admit from office
prepare H&P and fax to hospital
do initial hospital visit 5 pm that evening
CODE: 99221-99223 (mod -AI if medicare) as all E&M services that day roll into the admission E&M code


Monday, see patient at 3pm
Decide to direct admit from office
prepare H&P and fax to hospital
do initial hospital visit 6am Tuesday
CODE: 99201-99215 for the Monday Office visit
CODE: 99221-99223 (mod -AI if medicare) for the Tuesday initial hospital visit

Just a mention.......The initial hospital codes are for the initial inpatient encounter. There is sometimes confusion because they are referred to as "H&P was done". The 99221-99223 are for the first face-to-face inpatient visit not when the H&P was done.

So long story-short: You are correct. I have told our doctors that we cannot bill the initial hospital visit on the day that we admit the patient from the office, if we did not go to the hospital

 

[knic8867]

Thank you so much for the information, this will be beneficial to education our family physicians as well.