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Help please!!

  1. #1
    Question Help please!!
    Exam Training Packages
    I am really stumped on this one; I've seen this multiple times:

    I have a physician (Dr. A) who seen a patient on 2/8/2010 -- he writes a discharge summary for 2/9/2010 (99238). Assuming the patient is going home on 2/9/2010. The patient is still in the hospital. Another physician (Dr. B) sees the patient on 2/9/2010 and does a subsequent inpatient E/M (99232).

    I asked Dr. A why did he bill a discharge, the patient is still in the hospital. He says because he's rotation ended on 2/9/2010 -- thats what he suppose to bill. He has been doing this at least 3 times that I know of.

    My question to ANYBODY - Is this incorrect? What am I suppose to do?
    Karen, CPC
    Physician Chart Auditor

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by Gemini18 View Post
    I am really stumped on this one; I've seen this multiple times:

    I have a physician (Dr. A) who seen a patient on 2/8/2010 -- he writes a discharge summary for 2/9/2010 (99238). Assuming the patient is going home on 2/9/2010. The patient is still in the hospital. Another physician (Dr. B) sees the patient on 2/9/2010 and does a subsequent inpatient E/M (99232).

    I asked Dr. A why did he bill a discharge, the patient is still in the hospital. He says because he's rotation ended on 2/9/2010 -- thats what he suppose to bill. He has been doing this at least 3 times that I know of.

    My question to ANYBODY - Is this incorrect? What am I suppose to do?
    You know what happens when one assumes...

    He can't bill a discharge based on an assumption. He can't bill anything for that matter unless he actually provided the service and the documentation requirements are met. Did he charge for 2-8? Did he see the patient on 2-9-10? Does Dr. A share the same specialty as Dr. B? So many questions came to mind...

  3. #3
    Default
    Hi Rebecca -

    Thanks so much for answering!

    Dr. A, did see the patient on 2/8/2010. He did NOT see the patient on 2/9/2010. He assumed (as you said) the patient was going to be discharged. I do believe they are in the same speciality.

    I was thinking of telling him (Dr. A) he can bill a subsequent for 2/8/2010, not a discharge. He cannot bill a discharge because his rotation ended.

    Thanks again.
    Karen, CPC
    Physician Chart Auditor

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by Gemini18 View Post
    Hi Rebecca -

    Thanks so much for answering!

    Dr. A, did see the patient on 2/8/2010. He did NOT see the patient on 2/9/2010. He assumed (as you said) the patient was going to be discharged. I do believe they are in the same speciality.

    I was thinking of telling him (Dr. A) he can bill a subsequent for 2/8/2010, not a discharge. He cannot bill a discharge because his rotation ended.

    Thanks again.
    Dr. A could bill for a subsequent visit for 2-8 if he has supportive documenation. No visit on 2-9 equals no charge. Remind him that discharge codes require face-to-face, not to mention they are time based codes.

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Need clarification
    It sounds to me that Dr A believe that the discharge code is to be used when HE is discharging the patient (i.e. he's going off call and someone else will handle patient after today).

    He needs to know that the hospital discharge codes are ONLY to be used for the date the patient is actually being discharged from the hospital.

    In the scenario you mention Dr A should probably have coded a subsequent hospital visit. (Makes no difference if he was in the same practice or specialty as Dr B.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. #6
    Default
    Quote Originally Posted by FTessaBartels View Post
    It sounds to me that Dr A believe that the discharge code is to be used when HE is discharging the patient (i.e. he's going off call and someone else will handle patient after today).

    He needs to know that the hospital discharge codes are ONLY to be used for the date the patient is actually being discharged from the hospital.

    In the scenario you mention Dr A should probably have coded a subsequent hospital visit. (Makes no difference if he was in the same practice or specialty as Dr B.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    THANKS Tessa.

    I explained that to him. He didn't 100% agree, but said he would look into it.
    Karen, CPC
    Physician Chart Auditor

  7. Question marlyn cpc
    hello I have question i confront this issues every day. we have pts that are discharge example on 07/01/2011 a discharge summary was dictate and a discharge code 99238 was billed, the next day (07/02/2011) the patient is still in the hospital the doctor bills a follow up 99231 and dictates and addenum. wouldn't this be wrong? the physcian feels when they dictate a discharge summary they should bill a discharge since they did all the paper work, and the next day a follow.

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