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Hospital Transfer

  1. Default Hospital Transfer
    Medical Coding Books
    A physician performs 4 hours of critical care at a small local hospital then transfers patient to larger hospital in same day when condition worsens. At the larger hospital, the same physician (who has privledges at both) performs an Admit H & P and performs 4 more hours of critical care. How should this be billed? Can the same physician bill for hospital services at two locations on the same date of service?

  2. Default
    Keep in mind that critical care is not a "place" of service. CPT states that it is 30 minutes or more of direct patient care provided by the physician to a critically ill or injured patient, regardless of the location.

    You should treat the second admission as 4 more hours of critical care.

  3. Default
    This is going to depend on how he is billing.

    Scenario 1: Dr. is independant of either hospital, he will bill all services only once: Admit to new hospital (include all E&M services in figuring level) and 8 hours of critical care (if requirements in documentation and service provided met) {4 hours at 1st hospital followed by 4 hours at 2nd hospital).

    Scenario 2: Dr. is employee of both hospitals and does not bill his professional services independantly: You MAY be able to bill a discharge level for the 1st hospital depending on documentation in addition to critical care for both and admit to 2nd.

    Scenario 3: Dr. is independant of 1 hospital and employee of other. You MAY be able to bill same is in scenario 2.

    Another option: You might also want to look at the prolonged care codes, especially if the documentation does not meet critical care.

    Personally, the only way I would consider billing under scenario 2 or 3 is if the patient was discharged home from hospital 1 and then worsened and admitted to hospital 2. If patient was transferred, I would then go with scenario 1 regardless of employee status at either hospital.

    I am also assuming here that the 2 hospitals are NOT part of the same hospital system.

  4. Default
    Thank you for the great info! Scenario 1 applies here as the physician in question is independent and not an employee of either hospital. The hospitals are not part of the same system either.

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