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Office visit then admit several weeks later, can we bill ?

  1. #1
    Default Office visit then admit several weeks later, can we bill ?
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    Our patients usually come in through our clinic and it is decided at that visit the patient will need to have surgery. They are sent to pre-admit and labs that day then told to return several weeks later for surgery. On the day of surgery they report to clinic and sent straight up to surgery. Our doctor's are billing either 99214-99215 for the office visit, my question is can they also bill an admit code 99221-99223 on the admit day. They usually perform a H&P on the office visit day which is why they bill higher level office visits then on the day of admit they might do a brief H&P so if anything you would have enough for 99221. I dont think it would be appropriate to bill two visits since the office was already billed. If a patient comes in through clinic and admitted that day you can only bill one so why would this be any different ? Just want to make sure i'm on the right track cause my doctor's want to bill. Thanks

  2. #2
    Milwaukee WI
    Default NO separate Initial Hospital Visit
    Patient comes in for office visit and decision made patient needs surgery - Code the appropriate level office visit as per documentation and whether patient is new or established

    Patient sent to pre-admit and labs that day and told to return day of surgery - There is no separate code of this service ... you will include all the E/M provided on this date of service into the level of office visit you code.

    On day of surgery patient reports to clinic and is sent straight up to surgery - You code ONLY the procedure performed. The reimbursement for the procedure already includes the necessary pre-operative evaluation of the patient. The doctor is ALREADY BEING PAID for this service and should not separately code it.

    The only time you would code an initial hospital visit on the date of (or date immediately prior to) surgery is when that is the first encounter for this problem and the decision for surgery was made at that encounter. You would then append the -57 modifier.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 01-21-2010 at 02:51 PM.

  3. #3
    We bill for the physician's so we wouldn't bill the labs etc, but the initial visit we bill 99205 or 99215 since the decision to perform surgery is done that day and usually (99% of the time) the H&P is performed that day also and states in the H&P the patient is to report back to clinic on so and so date for surgery. I have always just billed the office visit and the surgery coder bills the surgery but the physician's are wanting to know why they can't bill an admit on the day of surgery since they are performing another H&P that day also. Like i explained to them, they already billed a high level office visit and completed a H&P so the day of surgery they should only bill the surgery. All the additional work up is bundled into the 90 surgery. I just wanted to make sure i was on the right track as far as inpatient visit's. Thanks again.

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