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Which E/M codes would I use?

  1. #1
    Location
    Daytona Beach, FL
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    Exclamation Which E/M codes would I use?
    Medical Coding Books
    Hi all - I took a couple of days off and came back to my desk full of billing issues! This one has me confused!

    A patient was admitted to the hospital on 01/11/10 and discharged on 01/12/10 with a dx of A-fib. According to the hospital system, the patient is listed as inpatient. The patient was seen by two different hospitalists - both according to their notes on the day of discharge and nothing on the day of admit. Between these two doctors, three claims were submitted, all for the same DOS. The insurance is denying stating only one service per specialty per day, which I understand, and of course they paid the lowest charge.

    The one doctor documented an H&P - dated 01/12/10 and billed 99235. Now patient is not listed as Observation and the patient was admitted the prior day, so I don't think this would be correct. She did document an admit, however the date does not coincide with the admit date and is also the same day as discharge.

    The other doctor who say the patient on the same date documented a visit note and a discharge summary. He billed a 99231 and then also billed an Observation visit of 99219. Again, patient is listed as Inpatient, not Observation - but was discharged by this doc on this date. The insurance paid the 99231 claim!

    How would you bill this visit? All opinions are welcome!

    Thanks,

    Jodi Dibble, CPC

  2. #2
    Default Inpatient
    Our rule of thumb is to bill consistent with the hospital's records so I would have, in this case, billed either 99235 which is observation OR IP care with POS 21 (depending on your payers rules; we have some that require separate admission and discharge notes on the same day by the same physician and others that allow them to be done by two physicians of the same practice) or an initial inpatient admission 99222 (based on the 99235 criteria of comprehensive, comprehensive, moderate) and left it at that.

    I would not have billed the subsequent, but this is just my opinion.

    Hope this helps.


    Quote Originally Posted by jdibble View Post
    Hi all - I took a couple of days off and came back to my desk full of billing issues! This one has me confused!

    A patient was admitted to the hospital on 01/11/10 and discharged on 01/12/10 with a dx of A-fib. According to the hospital system, the patient is listed as inpatient. The patient was seen by two different hospitalists - both according to their notes on the day of discharge and nothing on the day of admit. Between these two doctors, three claims were submitted, all for the same DOS. The insurance is denying stating only one service per specialty per day, which I understand, and of course they paid the lowest charge.

    The one doctor documented an H&P - dated 01/12/10 and billed 99235. Now patient is not listed as Observation and the patient was admitted the prior day, so I don't think this would be correct. She did document an admit, however the date does not coincide with the admit date and is also the same day as discharge.

    The other doctor who say the patient on the same date documented a visit note and a discharge summary. He billed a 99231 and then also billed an Observation visit of 99219. Again, patient is listed as Inpatient, not Observation - but was discharged by this doc on this date. The insurance paid the 99231 claim!

    How would you bill this visit? All opinions are welcome!

    Thanks,

    Jodi Dibble, CPC

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