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Physician billing-Inpatient to Swing Bed

  1. #1
    St Joseph
    Post Physician billing-Inpatient to Swing Bed
    Medical Coding Books
    Questions have come up about billing inpatient discharge and swing bed admits on the same day, by the same provider. We only bill the physicians services. This was brought up by our Medicare person. We are RHC and have to send those charges to Mutual, including Skilled (swing bed)and Inpatient services to Topeka. Our RHC rep says yes you can.
    Problem is do you need a specific note for Discharge and admit?
    OR - can you use a simple progress note with no mention of discharge as a discharge from inpatient to swing bed?
    OR - Is it required to have a discharge from inpatient? Dictated notes?
    AN - Is there some written information to prove all of this?
    Any help would be most appreciated. Thanks!!

  2. #2

    I worked in a RHC and we did many inpatient to swing beds on the same day. Technically, yes - you can bill both a discharge and admit on the same day and that is clearly stated in the policy. The catch is there needs to be documentation to support both services. When auditing I would look for a discharge note (handwritten or dictated) as well as an admission note that meets the requirement to bill a admit (using the nursing home codes). Unfortunately, this is where I found the problem and could rarely get supporting documentation to report both services. I usually got a discharge note but the admit would fall short of the required elements to report the lowest level admission (for a level 1 admit you need at least a detailed history, detaied exam and low MDM).

    As far as having this in writing - my point was always back to the basic "not documented, not done". You can bill out both but it would never be acceptable to bill out for a service that is not supported by documentation.

    does that make sense?
    Hope this helps some !
    Christie Musser, CPC

  3. #3
    CPT reads "For a patient discharged from from inpatient status to on the same date of nursing facility admission or readmission, the hospital discharge services should be reported using 99238-99239". Swing is billed with nursing facility service E/M so the same rules would apply.

  4. #4
    To answer part 2, discharge summaries are required in certain instances, so you may want to check the bylaws and/or policies that govern the hospital for when the physician is required to do so, as well as federal and state regulations. Our bylaws require a DC summary on any inpatient.

    As far as the admit note goes, you have to have an H&P to admit a patient, or you can use an H&P that was performed within the last 30 days as long as it is for similar circumstances, if an updated written/dictated admit note is done to document changes in hx and exam, unless this practice is not permitted by your bylaws/policies that govern your facility. BUT, it is allowed under federal regulation (I am also the Medical Staff Coordinator for my facility so I do have first-hand knowledge of this).

  5. #5
    Can you tell me what location you are using with swing bed? Since they never really move or change rooms, at least that is my understanding, and you are now using the nursing home CPT, do you change the location to 31 or 32?

  6. Default discharge hospital/admit swing bed
    I know this was asked above, but that was a while back.
    Is it appropriate and payable for a physician to bill a discharge from Hospital and Admit to hospital swingbed on the same day. Or, does he/she bill for subsequent visit and admit to swingbed?

    Thanks for any help given!

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