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When OP become admitted to IP.

  1. #1
    Location
    Columbus, Ohio
    Posts
    77
    Default When OP become admitted to IP.
    Medical Coding Books
    OK forgive me if this is a newbie question but I need clarification about physician billing for a patient who, for example comes to the hospital ER and stays for 2 days in outpatient status then on the 3rd day is admitted to inpatient. When the physician bills (not the facility) would this be:
    Day 1 (op)=outpatient initial visit code
    Day 2 (op)=outpatient subsequent visit code
    Day 3 (ip) = initial inpatient code or subsequent inpatient code ??

    Thanks in advance for your help

  2. Default
    our local hospital turn the whole stay to inpatient. Call your hospital to check their procedure

  3. #3
    Location
    Columbus, Ohio
    Posts
    77
    Default
    Let me rephrase my question:

    Quote Originally Posted by stephanie7480 View Post
    OK forgive me if this is a newbie question but I need clarification about physician billing for a patient who, for example comes to the hospital ER and stays for 2 days in outpatient status then on the 3rd day is admitted to inpatient. When the physician bills (not the facility) would this be:
    Day 1 (op)=outpatient initial visit code
    Day 2 (op)=outpatient subsequent visit code
    Day 3 (ip) = initial inpatient code or subsequent inpatient code ??
    Or turn Day 1 into initial IP code and code subsequent visits there after.

    I know that facilities turn the whole thing into inpatient but what about physicians that see the patients. I'll also need supporting documentation.

    Thanks in advance for your help

  4. #4
    Default
    If your physician ordered the Observation Status:

    Day 1 - Initial Observation Care

    Day 2 - Subsequent Observation Care

    Day 3 - Initial Hospital Care



    Other physicians use office/outpatient codes:

    Day 1 - Est/New OV

    Day 2 - Est OV

    Day 3 - Initial Hospital Care



    Supporting documentation can be found in the E/M section of CPT and from CMS.

    Highmark Medicare Services offers this training handout:
    https://www.highmarkmedicareservices...ed-april11.pdf

    Also, the February 2011 Coding Edge has an article on subsequent services of observation coding.

  5. #5
    Location
    Columbus, Ohio
    Posts
    77
    Default
    The presentation you provided the link to is awesome and answered my question. This is how I read it in the CPT but I need something from our MAC to present to my manager and the physician to educate them. I raised this issue over a year ago and I was told that I was wrong even though the Medicare Customer service rep told me the same thing. I'm frustrated because we are losing out on lots of revenue as a result.
    Also what issue of Edge Blast are you referring to?

  6. #6
    Default
    https://www.cms.gov/manuals/downloads/clm104c12.pdf (30.6.8) includes observation services.

    I didn't see any Obs nifty learning tools on the Palmetto website, only a couple of FAQs.

    The article on subsequent day obs services is in the February 2011 Coding Edge, page 16, not the Edge Blast.

    http://aapcperfect.s3.amazonaws.com/...1f8c8d873e.pdf

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