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Thread: Observation to Inpatient

  1. #11
    Join Date
    Apr 2007
    Albany, New York


    AAPC: Back to School
    Why not do a split-billing?

    Karen Maloney, CPC
    Data Quality Specialist

  2. #12
    Join Date
    Apr 2007
    Milwaukee WI

    Default Re-read my earlier post

    Quote Originally Posted by Anna Weaver View Post
    My question is:
    If you charge the patient as an inpatient from day 1 when they were actually admitted as observation, shouldn't your charges match the hospitals? When they have them in as outpatient for 2 days, that's what will be charged for room charges etc. (correct?) then you charge inpatient charges, if this visit is audited would this be a concern?
    You have a very valid point. But if you re-read my earlier post ... our hospital changes the status of the ENTIRE visit to inpatient once the patient has been admitted.
    So in the case of Mary Jane who was admitted to observation status on Sept 1, stayed in that status on Sept 2, was transferred to inpatient status on Sept 3, Stayed inpatient on Sept 4, and discharged Sept 5 ... The hospital we are affiliated with will change the status of Mary Jane's entire stay to inpatient, effective with Sept 1 (the first date she presented for service).
    I believe the hospital does not code their services until discharge; but don't hold me to that since I work for the doctors, not the hospital.

    So, our physician charges DO match the hospital's. That's why we wait to code until discharge, or at least 7 days of inpatient stay.

    F Tessa Bartels, CPC, CPC-E/M

  3. #13
    Join Date
    Apr 2007
    Kokomo, IN

    Default obs to inpt

    Thanks for clarifying, but I'm still confused. I would think that since the admitting orders are dated on the first date and state admit to observation, then 2 days later the orders are there for admit inpatient, if this is audited, the orders will not match the charges. Do you know if the hospital has been audited? I'm just curious and trying to understand. I've been told that you must, under no circumstances retro an admit.
    Thanks for helping me understand!!!

  4. #14


    I'm confused too

    If you are changing the entire stay to inpatient even from the day 1 when they were admitted to observation, how is that correct? it seems that they should only charge inpatient for the day they were inpatient to discharge. if they hospital changes the entire stay to inpatient, what does the physician bill for the services they rendered for obs and inpt?

    I guess from a hospital stand point, does it matter whether they are inpatient or outpatient? I don't know anything about hospital billing but do they indicate to the payer whether it's obs or inpt? because essentially regardless of status, they're billing the same thing right?

    please clarify...

  5. #15

    Default one possible solution

    We just tackled this question for our hospital group. It does make a difference if the hospital bills for outpatient and the doctor bills as inpatient. Many payers compare the place of service on both bills when processing a hospital stay.
    You should not retro an admit. Bill the observation code for day 1; if on day 2 the patient is admitted, bill the admit code. Documentation should show the order for admission and reference the original h&p but they don't have to redo the whole h&p. If the conversion happens on day 1 then bill only for the inpatient admission.
    For an observation that extends past 2 days, use an OP office visit code for those days.

  6. #16


    I guess Im just really confused on this. Some of the patients our docs are seeing as in-patient consultations have been put on abservation floors. Can the insurance companies deny these in-patient billings if theya re on observation?

    Please help.

  7. #17

    Smile Hi AR

    I'm look into billing for a hospital Nocturnits, do you have any information that can help me?
    Thank you

  8. #18
    Join Date
    Apr 2007
    Coeur d'Alene, Idaho


    The physical location of the patient does not matter. A patient may be on an "observation" floor but be inpatient. Likewise, a patient may be in the ICU and be observation status. The determining factor is the order for admission. I just did an audit on these for our clinic and the orders specifically state admit to observation or admit to inpatient. If your physician is not the admitting physician for the observation codes, then they will bill outpatient visit codes. If it is an inpatient then bill the inpatient codes appropriate to the service.
    Amanda Briggs, BS, CPC, CPMA, CCC, CEMC
    Coeur d'Alene, ID Chapter

  9. #19

    Default Observation to Inpatient

    I am billing a hospital claim, Do we bill for Observation charges as well as inpatient charges for the visit?

    Patient is placed into observation on 07/01, admitted on 07/02 and discharged on 07/03.

    Would we bill observation hours and 1 day of inpatient room and board?

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