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Physician Hospital Billing

  1. #1
    Default Physician Hospital Billing
    Medical Coding Books

    I need some help clarifing whether our physician has been billing hopital visits correctly. We are a small family practice and sometimes we have patients who end up in the hospital so one of our physicians get paged that they have a patient in the hospital. The next day the physician has billed either initial inpatient visit or subsequent hospital visit. What we are confused about is whether he should be using those codes since he is billing from the office not the hospital or is he suppose to use office visit codes? If any one can help us that would be great.


  2. #2
    Fort Smith, AR
    It sounds like you are billing the correct code. However, there should be a place of service code to indicate the patient's location or status. Place of service 11 would be physician's office and 21 would be Inpatient hospital. Hope that helps...

    Darla Sims CPC, CPC-H

  3. #3
    Milwaukee WI
    Default Observation
    And patients who are in "observation" would be in POS 22 Hospital Outpatient.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Milwaukee WI
    Default Codes = Place of Service
    Also, please note that the code used is based on the place of service (NOT the place of billing). So if the physician saw the patient IN the hospital, the correct code will come from the range of hospital -based CPT codes.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Ok, so it is ok to use the initial and subsequent codes even though the doctor is billing the services from our office. The claim form does show the service code 21 or 22 but it has our office address for the billing provider and the place of service address is the hospital.


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