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Thread: e/m for condition resolved

  1. #1

    Default e/m for condition resolved

    AAPC: Back to School
    I need a little advice. I have a patient who presented to the hospital for a scheduled procedure, but the condition resolved a few days prior so the procedure was not needed. Can the provider bill an established patient e/m for his time at the hospital?

  2. #2
    Join Date
    Apr 2007
    San Antonio, Tx


    Did he see the pt and fulfill the requirements for an E&M on the day you want to bill? If not, then NO CHARGE!
    Ray Galvez CPC

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Was patient admitted?

    Was the patient admitted as an inpatient? OR was the patient presenting for "day-surgery" (observation status, usually)?

    If patient was inpatient then you may have an initial H&P.

    If this was an outpatient surgery, you may have an established patient visit (POS 22).

    Of course, your documentation will determine what level of E/M (if any) you can bill.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4


    Thanks for the help! the patient was presenting for day stay and the provider did meet the requeirements for an E/M. I was leaning towards the established e/m, but just wanted to see what others thought.

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