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Thread: where can I turn for help

  1. #1

    Default where can I turn for help

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    I have told our doctors that we cannot bill the initial hospital visit on the day that we admit the patient from the office, if we did not go to the hospital. At a recent seminar the instructor said that if the doctors are dictating the admit note and then faxing it to the hospital so that when the patient arrives they can be directly admitted that we can bill the initial hospital visit instead of the office visit. Where do I find out what is the correct way? I need to have a concrete answer to bring back to the doctors.

    Any help would be greatly appreciated

    Denise Smith CPC-A, CEMC

  2. #2

    Default

    This is a paste from CMS:
    When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.

    It is better--and you want him to code--the "direct admit" encounter as an initial inpatient. Look at it this way, your Physician only gets one E&M service per day (generally). He can code the OV or he can code the Initial inpatient.

    If he codes the OV E&M, it will probably be denied as records will show was patient was Inpatient status on that DOS.

    The initial inpatient E&M codes generally have a higher RVU and reimbursement than the OV E&M (depending on level coded).
    Last edited by sbicknell; 05-25-2010 at 06:46 PM.

  3. #3
    Join Date
    Apr 2007
    Location
    Kokomo, IN
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    If you look at the codes 99221-99223 in CPT the description indicates "Physicians typically spend xx minutes at the bedside and on the patient's hospital floor or unit." So, we do not let the physicians charge an initial visit unless they present themselves to the hospital. If they admit from the office and do not present to the hospital, charge the office visit (per documentation) and then the next day, when the physician sees the patient, charge the initial visit (per documentation).
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  4. #4

    Default

    Here is a suggestion on explaining this to your Physicians............

    Monday, see patient in office at 10 am
    Decide to direct admit from office
    prepare H&P and fax to hospital
    do initial hospital visit 5 pm that evening
    CODE: 99221-99223 (mod -AI if medicare) as all E&M services that day roll into the admission E&M code


    Monday, see patient at 3pm
    Decide to direct admit from office
    prepare H&P and fax to hospital
    do initial hospital visit 6am Tuesday
    CODE: 99201-99215 for the Monday Office visit
    CODE: 99221-99223 (mod -AI if medicare) for the Tuesday initial hospital visit

    Just a mention.......The initial hospital codes are for the initial inpatient encounter. There is sometimes confusion because they are referred to as "H&P was done". The 99221-99223 are for the first face-to-face inpatient visit not when the H&P was done.

    So long story-short: You are correct. I have told our doctors that we cannot bill the initial hospital visit on the day that we admit the patient from the office, if we did not go to the hospital
    Last edited by sbicknell; 05-26-2010 at 11:56 AM.

  5. #5
    Join Date
    Apr 2007
    Posts
    13

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    Thank you so much for the information, this will be beneficial to education our family physicians as well.

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