1. User id : 7971 Posted 9 months ago #
   

   Dr. was asked to consult early AM in ER for bleeding, I used '99285.25'. It was elected to transfer this patient to another hospital. Our same Dr. did and H&P upon admission to 2nd hospital-observation status, and ordered an angiogram the same day. I used '99223.25'. I also charged '99217' for observation discharge the next day.
   '99285.25 denied for comprehensive/component procedures
   '99217' denied-included in primary procedure.
   Is is possible to get paid for the ER visit in the first hospital, and also for the complete H&P, and admission to second hospital the same day?

2. SuperCoder Posted 9 months ago #
   

   Who is the insurer?

   Jen Godreau, CPC, CPMA, CPEDC

3. User id : 7971 Posted 9 months ago #
   

   Healthspring

4. SuperCoder Posted 9 months ago #
   

   You will not be able to separately code the ED visit. CPT introductory guidelines specify, "When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g., hospital emergency department, observation status in a hospital, physician's office, nursing facility) all evaluation and management provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The inpatient care level of service reported by the admitting physician should include the services related to the admission he/she provided in the other sites of service as well as in the inpatient setting." Since you reported initial hospital care, the ED visit is included in that care. While the hospital is different, the same rule still applies. This is similar to providing an office visit for a patient and then sending him to the hospital and later seeing the patient on evening rounds and performing the H&P. The office visit work is not separately billable and that work should be included in the level of hospital care selected.

   For the hospital discharge, you should refile with 99238 or 99239 (if the documented total time spent on discharge day management is more than 30 minutes). Since you used initial hospital care on day 1, the discharge type does not match. If the admission documentation supports the physician admitting the patient to observation status (as you indicate), then you should have used 99220 rather than 99223.

   Jen

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