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Thread: Billing for Physician, sx done at the hospital

  1. #1

    Question Billing for Physician, sx done at the hospital

    AAPC: Back to School
    Hi Everyone,

    I am new at billing for hospital. I bill and code for my physician. The girl before me, used to do all the coding and billing for the doctor and for her cases that she performed at the hospital. My question is when a patient is inpatient, if I am billing for the physician, how do I bill for this. I have noticed that the previous girl billed all of the claims as outpatient. Is there a reason for that? should I be billing for inpatient or outpatient? I don't have the information of when patient was discharged and I am only billing the actual surgery performed by doctor. So I am not sure exactly how to bill it. Please help answer these questions.

  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    You need to find yourself a contact person at the hospital. Whether you bill inpatient or out will depend on the patients status with the hospital...and has nothing to do with the fact that your doctor is a "professional" provider, and not an in-house hospital provider.

    Call to either registration or medical records, and just explain that you are new and need to find out how to find out if the patient was in or out patient. My docs have always brought me back a "face sheet" from the hospital that usually includes info on the patients status.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3
    Join Date
    Apr 2007
    Daytona Beach, FL


    I don't know why she would have billed Outpatient for an Inpatient. That is not correct!

    Im not clear on what your doc is billing for by your question, but if they are seeing an Inpatient they would be using the inpatient codes - Inpatient consult (for non medicare) Initial visits for medicare consults or if they are the admitting doctor, subsequent visit codes for follow-up visits. If you are coding for the surgeries, then the visits in the hospital would be part of the global package and you wouldn't be billing those. If the patient is in Observation, then you would use the Observation codes if they are the admitting doc and the outpatient codes if they are not the admitting and are just consulting or following up on the patient.

    Hope this answers your question!
    Jodi Dibble, CPC

  4. #4

    Red face

    Thank you so much for the replies! My doctor only goes there to either assist in surgery or to perform surgery. The patient will come to the hospital for surgery and then stay either 1-3 days depending on how intense the surgery is and/or authorization allows. So when I am billing for the doctor, not knowing how many days the patient stays in hospital, I wasn't sure how to bill for her surgery off of the op report. The old coder was billing all as outpatient so that confused me a little. I figured I would ask if there was a reason she did that.

  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default I'm surprised these got paid

    I'm surprised the claims got paid if they didn't match the hospital's billing. We get denials if we use an outpatient POS when the hospital as billed for inpatient.

    If I read your brief post correctly, your physician is a surgeon. Visits may be global to the surgery (unless the admission was also the decision for surgery).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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