Results 1 to 4 of 4

Resolved diagnosis and inpatient visits

  1. Default Resolved diagnosis and inpatient visits
    Medical Coding Books
    Hello,

    Can anyone direct me to where I can find the answer to this question. Can a physician bill for a resolved diagnosis in the inpatient hospital setting? Example: The patient had hyperkalemia on the initial hospital visit and shows up as "resolved" on the third subsequent hospital visit and the physician billed for hyperkalemia, even though it's resolved...

    We have Noridian Medicare and we also work with Palmetto (Nevada) Medicare.

    Any help will be greatly appreciated..

    Thank you!

  2. #2
    Location
    Daytona Beach, FL
    Posts
    742
    Default
    Quote Originally Posted by 021402 View Post
    Hello,

    Can anyone direct me to where I can find the answer to this question. Can a physician bill for a resolved diagnosis in the inpatient hospital setting? Example: The patient had hyperkalemia on the initial hospital visit and shows up as "resolved" on the third subsequent hospital visit and the physician billed for hyperkalemia, even though it's resolved...

    We have Noridian Medicare and we also work with Palmetto (Nevada) Medicare.

    Any help will be greatly appreciated..

    Thank you!
    It would be helpful if the scrubbed note was posted to see what you are referring to.
    What do you mean by the physciain "billed" for hyperkalemia? Is that the only dx the patient had? If he was billing a subsequent hospital visit, the "resolved" dx of hyperkalemia would figure into his MDM for the E/M level - established problem, stable or improved for 1 point. This would be added up with any other dx he is treating to come up with the number of diagnoses/treatment options. If this is all the patient was in the hospital for, then I would assume he would be discharged.

    Thanks,
    Jodi Dibble, CPC

  3. Smile
    Quote Originally Posted by jdibble View Post
    It would be helpful if the scrubbed note was posted to see what you are referring to.
    What do you mean by the physciain "billed" for hyperkalemia? Is that the only dx the patient had? If he was billing a subsequent hospital visit, the "resolved" dx of hyperkalemia would figure into his MDM for the E/M level - established problem, stable or improved for 1 point. This would be added up with any other dx he is treating to come up with the number of diagnoses/treatment options. If this is all the patient was in the hospital for, then I would assume he would be discharged.

    Thanks,
    Thank you Jodi for responding, let me explain further...

    I guess all I need to know is , can a physician bill for a resolved diagnoisis in the inpatient setting? Yes or no? I know that you can bill for a rule out, probable diagnosis, but resolved?

    Thank you,

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by 021402 View Post
    Thank you Jodi for responding, let me explain further...

    I guess all I need to know is , can a physician bill for a resolved diagnoisis in the inpatient setting? Yes or no? I know that you can bill for a rule out, probable diagnosis, but resolved?

    Thank you,
    A physician cannot bill for rule out or probable in the inpatient setting, only the inpatient facility can do that. The provider must code code based on the information in each encounter. There fore if a condition has in fact resolved then no the provider cannot code it as though it were still current for that encounter. The exception is infections, infections are coded as thought they exist until after the encounter where it has been deemed resolved. In other words physician rules apply no matter the place of service.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. Resolved Dx and F/U visits
    By Dialmam in forum Diagnosis Coding
    Replies: 1
    Last Post: 04-10-2014, 12:22 PM
  2. Struggling with Inpatient Visits E/M
    By BABS37 in forum E/M
    Replies: 4
    Last Post: 03-28-2014, 12:11 PM
  3. Inpatient Consult Visits
    By sarthur in forum Billing/Reimbursement
    Replies: 1
    Last Post: 01-29-2014, 07:20 PM
  4. Inpatient visits
    By torihamill in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-30-2012, 12:49 PM
  5. Resolved diagnosis and inpatient visits
    By Love Coding! in forum Diagnosis Coding
    Replies: 0
    Last Post: 05-10-2011, 10:33 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.