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Code this scenario please:

  1. #1
    Default Code this scenario please:
    Medical Coding Books
    Here's the scenario: patient came in ER was treated by ER staff and put in observation, they decide to discharge patient with in 23 hours, House docs come in and do patient's discharge, patient leaves without being ever admitted as inpatient.


  2. #2
    Based on what you are saying the ER doc would bill the admit to obs and then the house doc would only get an outpatient E/M, either new or established. Nobody gets the discharge, since only the admitting provider can bill for a discharge.

    Laura, CPC

  3. #3
    So the house doc can bill outpatient E/M

  4. #4
    It depends. Was the house doc just doing the discharge or was it a consult? I don't think that the house doc can charge at all unless it was a consult. When a pt is admitted and discharged as an OBS pt within a 24-hour period, there should only be one OBS code used, unless it was a different DOS entirely. I am extremely confused by OBS codes (even though I do them here at my hospital) so please, correct me if you think I am wrong....

  5. #5
    I see no reason the house doctor would not be able to bill an outpatient E/M.

    This policy talks about the admit and discharge and what that physician can charge if the obs goes over 2 days. My understanding based on cms is that only the admitting provider can bill for a discharge. Everyone else gets consults, subsequent days, or in this case outpatient E/M. If this is incorrect I hope someone will please post a link to the information showing otherwise and I will take that to our medicare carrier and ask for clarification.

    I don't personally agree with only allowing the admitting provider to do the discharge. There are many times my providers take over care on someone elses patient, but we didn't admit so we only get subsequent days.

    Laura, CPC

  6. #6
    But was her example for a patient that was there over 2 days?


  7. #7
    Milwaukee WI
    Default House doc
    Based on how you worded the scenario it seems that the ER did the admission AND made the decision for discharge ... so I agree that in this case the house doc codes an outpatient visit (either new or established depending on whether the practice/specialty has seen the patient in the last 3 years).

    However ... if the ER doc said "this patient needs observation" and the house doc (who is the official "admitting" physician) didn't get there to do the initial visit until it was time to discharge ... then the ER doc bills for ER services and the house doc codes the 99234-99236 (admit & discharge on same DOS).

    At our hospital the ER doc NEVER codes an admission (either inpatient or observation).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 07-23-2009 at 11:55 AM.

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