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Two Different POS same patient

  1. #1
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    Loma Linda
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    Red face Two Different POS same patient
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    If a patient has been seen in a inpatient hospital and your doctor has been treating the patient for wound care while in the hospital and get released from the hospital can he bill for seeing the patient at a different place of service. Wound care center not related to the orginial hospital.

    does it fall under the global period

    Sarah:
    Last edited by smaxwell4; 10-22-2008 at 05:16 PM.

  2. Default
    Sara,

    Am I understanding this correctly?

    This patient was already being treated by your provider for wound care.

    This patient then went into the hospital for something unrelated to the wound care.

    While inpatient, your provider continued to perform wound care on this patient.

    Now the patient is out of the hospital and you are wondering if your provider may continue to bill for the same wound care?

  3. #3
    Location
    Loma Linda
    Posts
    17
    Red face
    he is the consulting doc. he is not the admitting doc for the patient. He is ask to see the patients that develop wounds or already have wounds. So the patient would leave that hospital and another physician(either pcp or the admitting doc) would send the patient to a wound center or from the wound center to the hospital and wound ask my doc to see the patient again.
    Hope that makes a little more sense.

    Sarah

  4. Default
    Sara,

    As an auditor, the first concern is if your provider is a wound care specialist and is being asked to see a patient for a wound in the hospital setting, that this may not be a consult.

    Barring that, I'm still not understanding completely. Let me ask a couple more questions;

    Is your posted question always regarding a patient your provider has already seen as an inpatient?

    If so, what ranges of procedure codes is your provider billing when the patient is seen by him/her as an inpatient?

  5. #5
    Location
    Loma Linda
    Posts
    17
    Red face
    Yes the patient a inpatient if they are seen in the hospital. He bills for the inital consultation usually 99254 to 99255. any visits after that he bills 99232.
    He may do some debriedment or other wound care in the hospital and then the patient might get transfered because they longer need to be in the hospital setting to the wound clinic setting which is an outpatient facility. He follows the patient there and since if he did a procedure on them in the hospital and now they are moved to another facility can he bill for seening them at the other facility during the global period. I think I am asking it right. Not sure.

    Sarah

    What if POS changes? Pt leaves hospital and is seen @ woundcenter? Or vice versa. Could he start billing from new POS of does global period follow wherever the patient goes?

    Hopefully this make some sense

    Thanks

    Sarah, CPC
    Last edited by smaxwell4; 10-23-2008 at 03:36 PM. Reason: Adding more information. Rewording the question

  6. Default
    Sara,

    I think I'm understanding a little better.

    To answer your last question first, yes, global periods follow the patient wherever your provider see's the patient, e.g., does not matter whether the patient is seen in the hospital, office or in an outpatient area of the hospital, etc.

    Also, unless his E/M, aka office visits/subsequent care, is not related to the wound care, or goes above and beyond what normal wound care would entail, they are not separately billable.

    With that being said, I am still going to recommend verifying that the requesting providers intent is for your provider to perform a consult and not to simply take over the care of the problem. Especially with consultations being such a highly scrutinized and sensitive issue with carriers, CMS, and OIG right now. It will be well worth the reduction in receivables in the long run, to not be found billing a consult in error and having to refund the money originally paid, pay additional fines and pay triple the amount of what was originally paid on each claim.

    I know that was a lot of information, and perhaps you are well educated in that area. Better too much information than not enough.

    Hope that helps!

    Kris

  7. #7
    Location
    Loma Linda
    Posts
    17
    Red face
    Kris,

    Thank yo very much. It does help.

    When he is first ask to see the patient the referring ask him to consult the patient and depending on the finding depends on whether or not he continues to see the patient. These patients are not in the facilities for the problem my physician is seeing them for. 2nd problem . He also sees alot of SFN patients.


    Sarah
    Sarah M., CPC

  8. Default
    Sarah,

    Does he ever not see a hospital patient a second time?

    Kris

  9. #9
    Location
    Loma Linda
    Posts
    17
    Red face
    Kris,
    Yes he does. But sometimes they will get transfer to another facility sometime by a different physician and they ask him to see the patient again. Or the patient gets release from the hopital and the referring phyisican wants my doctor to follow them up in the wound center


    Sarah
    Sarah M., CPC

  10. Default
    Sarah,

    Gotya. Ok. Does he ever get asked to see a patient in the hospital, perform a consult and then determine he does not need to see the patient again? That the provider who requested him to see the patient can take care of the patient with your providers opinion and advice?

    Kris

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