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patient seen in ER, admitted to Hospital and discharged/tranfered by same doc & day

  1. #1
    Default patient seen in ER, admitted to Hospital and discharged/tranfered by same doc & day
    Medical Coding Books
    I recieved a charge sheet from one of my doctors(I work in a family practice with providers that have hospital rights). He "moonlights" in the ER and saw a patient while working in ER. He decided to have the patient admitted and performed the H & P as well. Later in the day he decided to discharge her and have her tranferred to a larger hospital. The charge that he gave me was a 99235-admit/discharge same day. I am not sure if this is correct or if only the visit from the ER(which is billed through a different company) is the only thing that can be charged out by him for this date of service?

    Does anyone know how this plays out? I think I have provided enough info but would be happy to provide more in order to narrow down an answer! Thanks in advance!!

  2. #2
    Kansas City, MO
    So... he is the ER doc AND the attending?? This is unusual.

    I think its one or the other. He should not be billing the ER visit and the admit & d/c same day....but I have never heard of a situation where the ER doc admits and then becomes the attending.

    In our cases, the ER docs calls in a specialist of the family doc to do the "admit", and those docs will roll up any work done in the ER into their "admit"

    Than again...maybe I am confused by the situation!

    Maybe if he is an ER doc for a separate entity (not affiliated with hospital) and then he puts on his "new hat" and becomes the attending, and the documentation is completely separate...I dunno...kinda just thinking outloud at this point...I hope someone has a more solid answer for you
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC, AAPC Fellow
    PMCC Licensed Instructor
    2018 Chapter President, Kansas City, MO

  3. #3
    I agree with Linda, you docotor needs to choose either the ER code or admit/discharge, it is his choice but he can't bill both on the same day.

    Hope this helps,

    "Life isn't about waiting for the storm to pass...It's about learning to dance in the rain."

  4. #4
    Yes, the situation is odd! We are a small community hospital so a few of our doctors wear several hats! They work in ER, see patients admitted to the hospital and then follows up with them as their family provider. We have had the discussion before whether or not they could charge the hospital visit since they bill under another tax ID number through the ER. It was concluded that regardless of where they are in the ER they are still the same entity and there for cannot "double dip". Also, since they are on the clock with ER they shouldn't be seeing patients in the hospital. I was just thinking maybe I could charge a discharge and not the admit/discharge but it was all within the same 24 hour period so I will have to break the bad news to him.

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