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Thread: Inpatient vs Outpatient e/m code in a Radiation Oncology Center

  1. #1
    Join Date
    Apr 2007
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    12

    Question Inpatient vs Outpatient e/m code in a Radiation Oncology Center

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    I work for a large corporation in the Northwest. We have a Radiation Oncology Center which is a 'stand alone' facility.

    We have patients who are admitted to the hospital and while in the hospital are referred to the Radiation Oncology Center to discuss treatment options. They do NOT discharge the patient and transport them to the Rad Onc Center for a consultation for treatment.

    Would the consultation code be an inpatient e/m consult code or outpatient? Would you document as an inpatient or outpatient?

    Thanks for your help,

    dianna

  2. #2
    Join Date
    Apr 2007
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    Default

    My set up is different and I don't have rad/onc but I can tell you what we do in similar situations.

    We bill what we do. If my doctors goes in the hospital and does a consult we bill an inpatient consult pos 21. If the patient comes to the office we bill an outpatient consult with pos 11. Doesn't matter if the patient is technically inpatient, we are using our staff and our resources and the service was provided in our outpatient office.

    I have one practice this happens in fairly regularly and the only time we have ever had a rejection was for the inpatient side. We saw the patient as an inpatient and billed as such but the insurance reviewed the case and took it down to an obs status so we had to change our coding after the fact in that case.

    Just my experience for what its worth,

    Laura, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
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    12

    Default Inpatient vs Outpatient e/m code in a Radiation Oncology Center

    Thanks Laura...its always nice to get a 2nd opinion ;0)

    dianna

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