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Inpatient Billing Help

  1. #1
    Columbus Ohio
    Default Inpatient Billing Help
    Medical Coding Books
    Hello Everyone
    I have been a physician coder for 6 years now. I have my CPC and CPC-H. I just took a position auditing inpatient bills over $20,000. It is so different then physician billing. I am lost without the CPT codes. They just bill a flat amount and a small description of the services. I have been trying to read everything I can and looked at Medicare's website for information. Does anyone have any other resources I might be able to use to make sure I am understanding the charges without the CPT codes? My manager told me I could order any books I want but I am not sure which ones would be the best since they just give you a brief description of the book. I wish there was a place I could actually go look at the books and see what ones would be most helpful. If anyone does inpatient billing and have a book that is really helpful I would really appreciate knowing what it is. Any resources would be very much appreciated. I am really excited about this position and want to do a great job. I do already have a DRG book but I don't have to audit DRG charges.

    Thank you.

  2. #2
    For the most part you have just the room and board charges, supplies, labs, drugs, and surgical charges. What exactly are you trying to find to help with what?
    Herbie W Lorona Jr., CPC, CPC-H

  3. #3
    Columbus Ohio
    I am looking for what charges a hospital can or can not bill for. For example were I work we don't pay for a bp monitor or any monitor because it is reused for other patients.

    Also the way they list the items on their invoice I am having trouble know exactly what it is since they don't use CPT codes. I have tried using medicare's site for abbreviations but they are never on there.

    I want to know if the hospital is billing for something that is included in the room charge for the patient.

    I am use to having a cross coding book that I can look CPT codes up in and see that they are bundled or that procedure is not medically necessary with that diagnosis code.

    Does that make sense? I hope it does. I would really appreciate any help anyone could give me.
    Thanks Amy

  4. #4
    It has been awhile since I worked in the hospital setting but they would list everything they done on the bill. Every lab they performed drug they used surgery done supply used you name it. They get paid based off the room and board charges or the drg. So if the patient was there for 10 days on a regular bed and 2 days on a surgical bed they will get paid for the two days of surgical which are usually higher then a regular day and the 10 days at the regular days. With Medicare they paid based off the diagnosis in which was billed. If the patient was there for 8 days for a minor diagnosis they would probably pay less then if the patient was there for 5 days for a more complex diagnosis. Email me at if you need anymore help. Maybe I can help you more!
    Herbie W Lorona Jr., CPC, CPC-H

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