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Inpatient Billing to AZ Medicaid

  1. Lightbulb Inpatient Billing to AZ Medicaid
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    If you have a Physician that is employed at a general clinic (place of service 11) and the patient is seen in the Urgent Care and that Physician decides to admit the patient to the inpatient hospital facility (place of service 22) which this Physician has admitting privileges at this hospital, how to do you bill the professional claims?
    Do you bill the UC outpatient POS 11 claim and the admit/subsequent inpatient stay POS 22 claim? Or do you close the Outpatient Urgent Care professional claim and choose an admit E/M that encompasses the urgent care services for the Hospital and bill one professional claim?

  2. #2
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    Columbia, MO
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    Medical Billing
    If the physician sees a patient in the office setting or urgent care setting and makes the decision to admit on the same day .. then you should bill the initial inpatient admit level only. also the POS for inpatient is 21 not 22.

    Debra A. Mitchell, MSPH, CPC-H

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