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Thread: hospital E/M billing

  1. #1

    Default hospital E/M billing

    AAPC: Back to School
    Asking for your advice on this matter

    __________________________________________________ _______

    Your physician has told you that on his hospital billing if he writes:

    "new" and a dx - it is equal to a 99254, unless otherwise specified

    "a check mark" and a dx - it is equal to a 99232, unless otherwise specified

    "admit" and a dx - is equal to a 99223, unless otherwise specified

    "New ER" and a dx - is equal to a 99244, unless otherwise specified
    __________________________________________________ ___________

    If we were ever audited, would billing submitted in this method hold up in an audit?

    Would an auditor take what level was billed, and then use the physician's documentation to substantiate the billing which would make the billing he submitted to the billing department irrelevant to the audit?

    But it is a complicated issue, because I was also told by a few sources that a physician's billing is considered a legal document, and as such must be kept in case of audits. So by this reasoning then this is also a key factor in the audit.

    (this is what the physician's billing would resemble)

    Jane Doe, hospital medical record # 0000000, new, nausea and vomiting
    (I would bill this a 99254 for nausea and vomiting, following the billing guidelines the physican provided above.)
    Last edited by Colliemom; 08-04-2009 at 07:43 AM.

  2. #2
    Join Date
    Apr 2007


    I would say if he is giving you a billing sheet to bill the visits it would be kinda hard for you to know. Without seeing the actual progress notes he does then there is really nothing else you can do but bill what he is giving you!
    Herbie W Lorona Jr., CPC, CPC-H

  3. #3
    Join Date
    Apr 2007
    Boston, MA


    This is very little information to go by. Does he at least supply the name of the requesting provider to bill the level 4 consult in the example? Without knowing anything else about the situation I would have reservations.
    Karolina, CPC, CPMA, CEMC

  4. #4
    Join Date
    Apr 2007
    Boston, MA


    In case of an audit the documentation must support the charge - his note has to support the type and level of service billed.
    Karolina, CPC, CPMA, CEMC

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