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Discharge & Readmission same DOS

  1. #1
    Default Discharge & Readmission same DOS
    Medical Coding Books
    How do you bill if the same doctor or group discharged a patient in the morning and then readmitted later, same DOS, same diagnoses?

    I know Medicare and most payors would deny this since they are bundled w/ and indicator of 0.

    Do you just bill a new admit only and combine the documentation for a possible higher level of service?

    I know you can do this w/ regular rounds if the same doc or docs in the same group/same specialty see the same pt on same DOS.. just not sure if it would apply in this situation.

    I can't find any guidelines regarding this particular scenario.



  2. Default
    Interdepartmental transfers or readmits will be paid if coded with subsequent hospital care codes (99231-233). This is what I observed from a Payor. I am not sure if it can be applied to all.
    Jagadish, CCS-P, CPC

  3. #3
    Not for Medicare. I still can't find a definitive answer on this... I've posted all over the place and got 4 different answers....


  4. Default

    Please check the follwoing:

    E. Physician Services Involving Transfer From One Hospital to Another; Transfer Within Facility to Prospective Payment System (PPS) Exempt Unit of Hospital; Transfer From One Facility to Another Separate Entity Under Same Ownership and/or Part of Same Complex; or Transfer From One Department to Another Within Single Facility
    Physicians may bill both the hospital discharge management code and an initial hospital care code when the discharge and admission do not occur on the same day if the transfer is between:
    Different hospitals;
    Different facilities under common ownership which do not have merged records; or
    Between the acute care hospital and a PPS exempt unit within the same hospital when there are no merged records.
    In all other transfer circumstances, the physician should bill only the appropriate level of subsequent hospital care for the date of transfer.
    Jagadish, CCS-P, CPC

  5. Default admit and discharge to a different facility on the same day
    Does any one know what should be billed if the same physician admits and pt and on the same day discharges the pt to a different facility? Thanks

  6. Default admit/discharge same day
    I'm looking at observation admit/discharge same date codes 99234-99236.

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