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Billing inpatient status for pts seen in the office

  1. #1
    Vancouver Washington
    Default Billing inpatient status for pts seen in the office
    Medical Coding Books
    I really need to be directed to some guidelines regarding this.

    I code for a group that has an office in the professional building attached to one of our local hospitals. Some of the patients being seen are inpatient at the hospital and are brought over for a consult or some type of treatment. I'm not exactly sure why the doctor doesn't round on them in their room, but I need to know if its ok that the doctor is using inpatient codes, and an inpatient place of service for these patient. Can someone direct me to something definitive regarding this?
    Jaime Wicklund, CPC

  2. Talking
    Per Inpatient Consultation category header notes in CPT "The following codes are used to report consultations provided to hospital inpatients......."

    then in the front of the CPT book under place of service codes for professional claims look under place of service 21. A facility other than by or under the supervision of physicians to patients admitted for a variety of medical conditions.

    The key part of this is that the patient has formally been admitted and has not yet been formally discharged from inpatient care. Hope that helps

  3. #3
    Vancouver Washington
    I understand what you are saying, and their is no question about the status of the patient. My concern is that providing the service in the office would change the pos to 11, not 21. but if I do this then their is a discprency with the insurance company that the patient cannot be present at a doctors office, if they are inpatient at the hospital. Any thoughts?
    Jaime Wicklund, CPC

  4. Default
    I work for an insurance carrier as a coder and I can tell you that your claim will deny if your POS doesn't match the facility. Another good way to think of it is "code where you land" (the patient lands)

  5. Default
    Medicare wants us to use Inpatient as the POS... but would our location be here at our office or the hospital the patient is a inpatient at? Any help would be fabulous! Thanks!

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