Initial Hospital Care From Emergency Room
Contractors pay for an initial hospital care service or an initial inpatient consultation if a physician sees his/her patient in the emergency room and decides to admit the person to the hospital. They do not pay for both E/M services. Also, they do not pay for an emergency department visit by the same physician on the same date of service. When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.
In your particular scenario, the admitting physician was not a member of your group,therefore, your physician could bill for the office visit. The level would be based according to his documentation.
Hospital admission following an office visit
Q When a physician sees a Medicare patient in the office and, in the course of the office visit, determines that hospital admission is required, how should this be coded? Is it necessary to visit the patient again in the hospital after having seen him or her in the office, or is the time spent with the patient in the office sufficient to fulfill the requirements for the admission code?
A To submit an inpatient care code, you have to see the patient in the hospital. If you provide the office visit and see the patient in the hospital later that day, you'll be paid only for the inpatient care code, because Medicare states that "All services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission." If you don't see the patient in the hospital until the next date, you will be paid for both the evaluation and management visit and the inpatient care, because Medicare also states that "Carriers pay both visits if a patient is seen in the office on one date and admitted to the hospital on the next date, even if fewer than 24 hours has elapsed between the visit and the admission."
Again...the key element in your scenario is that your physician was not the admitting physician.
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